Healthcare Provider Details

I. General information

NPI: 1316185325
Provider Name (Legal Business Name): TRACI A KALPAC LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ARCH ST SUITE G2
AKRON OH
44304-1429
US

IV. Provider business mailing address

525 E MARKET ST PO BOX 2090
AKRON OH
44304-1619
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-4100
  • Fax: 330-375-4097
Mailing address:
  • Phone: 330-996-8603
  • Fax: 330-996-8695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI0700186
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: