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General NPI Number Information
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NPI Number | 1336949312
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Entity Type | Individual
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Provider Name | TRACY LORETTA GROCHOW M.A
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Gender | Female
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 17685 JUNIPER PATH STE 303
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City | LAKEVILLE
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State | MN
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Zip | 55044-9821
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Country | US
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Telephone | 952-214-8959
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Fax |
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Provider Business Mailing Address
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Address Line | 4896 BISSET LN
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55076-1319
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Country | US
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Telephone | 651-442-3384
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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