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NPI Code Detail

MEDICARE: TRACIE HEACOX

MEDICARE: TRACIE HEACOX
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1003437765
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACIE HEACOX
Provider Business Mailing Address
First Line : 6128 PENN AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55419-2035
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6200 BURY DR
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55346-1718
Country : US
Telephone Number : 866-822-7464
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2020
Last Update Date : 05/04/2020

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Directions to “ TRACIE HEACOX ” Practice Location

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