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General NPI Number Information
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NPI Number | 1750041596
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Entity Type | Individual
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Provider Name | TRACEY LYNNE ROAT RSST
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Gender | Female
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Dates
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Enumeration Date | 12/21/2021
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 2700 W GENESEE AVE
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City | SAGINAW
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State | MI
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Zip | 48602-3723
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Country | US
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Telephone | 989-799-1266
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 ALLENDALE DR
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City | SAGINAW
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State | MI
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Zip | 48638-4403
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Country | US
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Telephone | 989-860-2781
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6803086673
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License Number State | MI
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