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NPI Code Detail

MEDICARE: TRACI H REGIS MS, LPC

MEDICARE: TRACI H REGIS MS, LPC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor15445-131WI
2101YP2500XProfessional Counselor4464-125WI

General Provider Information

NPI Number : 1205069077
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACI H REGIS MS, LPC
Provider Business Mailing Address
First Line : 4960 FIELD CREST LN
Second Line :
City : EAU CLAIRE
State : WI
Zip : 54701-1106
Country : US
Telephone Number : 612-424-9940
Fax Number :
Provider Business Practice Location Address
First Line : 4960 FIELD CREST LN
Second Line :
City : EAU CLAIRE
State : WI
Zip : 54701-1106
Country : US
Telephone Number : 612-424-9940
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2009
Last Update Date : 05/09/2024

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