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General NPI Number Information
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NPI Number | 1669384368
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Entity Type | Individual
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Provider Name | TODD TRACY
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Gender | Male
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Dates
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Enumeration Date | 09/18/2026
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Last Update Date | 09/18/2026
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Provider Practice Location Address
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Address Line | 194 SUN MEADOW CT
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City | HOLLAND
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State | MI
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Zip | 49424-6649
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Country | US
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Telephone | 616-795-6796
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Fax |
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Provider Business Mailing Address
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Address Line | 194 SUN MEADOW CT
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City | HOLLAND
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State | MI
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Zip | 49424-6649
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Country | US
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Telephone | 616-795-6796
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 6801084356
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License Number State | MI
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