MEDICARE: TRACY J COLLIER LSW

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
1	104100000X	Social Worker	S.1701780	OH

General Provider Information

NPI Number	:	1275039984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY J COLLIER LSW

Provider Business Mailing Address
First Line	:	2332 GRANDVIEW AVE APT 2
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-3120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2332 GRANDVIEW AVE APT 2
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-3120
Country	:	US
Telephone Number	:	303-910-2624
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2018
Last Update Date	:	06/29/2024

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