MEDICARE: TRACEY M WEATHERSPOON

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	374J00000X	Doula

General Provider Information

NPI Number	:	1417832643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY M WEATHERSPOON

Provider Business Mailing Address
First Line	:	727 W GRAND BLVD APT 125
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48216-2124
Country	:	US
Telephone Number	:	313-289-9180
Fax Number	:

Provider Business Practice Location Address
First Line	:	727 W GRAND BLVD APT 125
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48216-2124
Country	:	US
Telephone Number	:	313-289-9180
Fax Number	:

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

Provider Enumeration Date	:	08/07/2025
Last Update Date	:	08/07/2025

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Directions to “ TRACEY M WEATHERSPOON ” Practice Location

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