Healthcare Provider Details

I. General information

NPI: 1629685391
Provider Name (Legal Business Name): TRACY WHEELER LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4661 SAWMILL RD STE 3
COLUMBUS OH
43220-6123
US

IV. Provider business mailing address

4661 SAWMILL RD STE 3
COLUMBUS OH
43220-6123
US

V. Phone/Fax

Practice location:
  • Phone: 614-364-4680
  • Fax:
Mailing address:
  • Phone: 855-857-6050
  • Fax: 937-548-1500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2204147
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: