=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558694919
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRACY H ENGEL MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2009
-----------------------------------------------------
Last Update Date | 07/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 651 S LIMESTONE ST
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45505-1965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-321-1111
-----------------------------------------------------
Fax | 937-232-2336
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 651 SOUTH LIMESTONE STREET
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-321-1111
-----------------------------------------------------
Fax | 937-322-3368
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | S.0700546
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------