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General NPI Number Information
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NPI Number | 1396108163
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Entity Type | Individual
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Provider Name | DENAE TRACY
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Gender | Female
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Dates
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Enumeration Date | 03/30/2016
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Last Update Date | 03/30/2016
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Provider Practice Location Address
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Address Line | 25 CARE DR
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City | HILLSDALE
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State | MI
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Zip | 49242-5054
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Country | US
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Telephone | 517-439-2641
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Fax |
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Provider Business Mailing Address
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Address Line | 3580 LONG LAKE RD
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City | READING
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State | MI
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Zip | 49274-9779
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Country | US
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Telephone | 517-215-1713
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6802088221
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License Number State | MI
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