MEDICARE: TRACY ANN WILSHUSEN

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	1041C0700X	Clinical Social Worker	104938	TX

General Provider Information

NPI Number	:	1306699277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY ANN WILSHUSEN

Provider Business Mailing Address
First Line	:	8150 N CENTRAL EXPY STE 1625
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-1806
Country	:	US
Telephone Number	:	214-530-0021
Fax Number	:	214-530-0021

Provider Business Practice Location Address
First Line	:	24900 PITKIN RD STE 290
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-2004
Country	:	US
Telephone Number	:	214-530-0021
Fax Number	:	214-530-0021

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

Provider Enumeration Date	:	04/09/2024
Last Update Date	:	04/15/2024

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Directions to “ TRACY ANN WILSHUSEN ” Practice Location

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