Healthcare Provider Details

I. General information

NPI: 1437592763
Provider Name (Legal Business Name): TRACY ANN CROGHAN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRACY SHERWOOD

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 WOOLWORTH AVE
OMAHA NE
68105-1850
US

IV. Provider business mailing address

663 N 132ND ST
OMAHA NE
68154-4031
US

V. Phone/Fax

Practice location:
  • Phone: 402-599-2189
  • Fax:
Mailing address:
  • Phone: 402-709-9802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6863
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1589
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: