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General NPI Number Information
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NPI Number | 1750105664
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Entity Type | Individual
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Provider Name | TRACEE GUENTHER
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Gender | Female
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Dates
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Enumeration Date | 11/08/2024
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 345 W HOOVER ST
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City | WESTFIELD
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State | IN
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Zip | 46074-9283
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Country | US
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Telephone | 317-867-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 9405 CAMERON RIDGE LN APT 133
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-7709
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Country | US
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Telephone |
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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 | 10312401
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License Number State | IN
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