MEDICARE: TRACY DENISE CLARK

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	171M00000X	Case Manager/Care Coordinator		OH
2	374U00000X	Home Health Aide		OH

General Provider Information

NPI Number	:	1497439731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY DENISE CLARK

Provider Business Mailing Address
First Line	:	1425 VIRGINIA AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44306-3650
Country	:	US
Telephone Number	:	133-070-1042
Fax Number	:

Provider Business Practice Location Address
First Line	:	1425 VIRGINIA AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44306-3650
Country	:	US
Telephone Number	:	330-701-0421
Fax Number	:

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

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	05/19/2026

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Directions to “ TRACY DENISE CLARK ” Practice Location

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