Healthcare Provider Details

I. General information

NPI: 1346659307
Provider Name (Legal Business Name): TRACI PAGE MA LPCC LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 5TH ST NW STE E
ELK RIVER MN
55330-5711
US

IV. Provider business mailing address

5560 145TH CIR NW
RAMSEY MN
55303-5168
US

V. Phone/Fax

Practice location:
  • Phone: 763-458-2967
  • Fax: 763-260-5150
Mailing address:
  • Phone: 763-458-2967
  • Fax: 763-260-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number940
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: