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General NPI Number Information
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NPI Number | 1669895330
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Entity Type | Individual
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Provider Name | TRACY SPIRES ED.S, NCSP
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Gender | Female
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Dates
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Enumeration Date | 01/30/2014
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Last Update Date | 01/30/2014
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Provider Practice Location Address
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Address Line | 325 W STATE ST
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City | GEORGETOWN
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State | OH
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Zip | 45121-1229
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Country | US
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Telephone | 937-378-6118
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Fax |
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Provider Business Mailing Address
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Address Line | 598 BLUE CREEK RD
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City | STOUT
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State | OH
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Zip | 45684-9679
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Country | US
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Telephone | 937-549-4373
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | OH1315708
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License Number State | OH
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