Healthcare Provider Details

I. General information

NPI: 1629932694
Provider Name (Legal Business Name): TRACY CROCKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1446 MANCHESTER RD
AKRON OH
44314-3358
US

IV. Provider business mailing address

1446 MANCHESTER RD
AKRON OH
44314-3358
US

V. Phone/Fax

Practice location:
  • Phone: 330-926-7591
  • Fax:
Mailing address:
  • Phone: 330-926-7591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: