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NPI Code Detail

MEDICARE: MRS. TRACI LYNN SCOTT LLMSW

MEDICARE: MRS. TRACI LYNN SCOTT LLMSW
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
11041C0700XClinical Social Worker6851117126MI

General Provider Information

NPI Number : 1558042697
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TRACI LYNN SCOTT LLMSW
Provider Business Mailing Address
First Line : 700 WASHINGTON AVE STE 220
Second Line :
City : GRAND HAVEN
State : MI
Zip : 49417-1462
Country : US
Telephone Number : 616-842-6710
Fax Number : 616-842-1103
Provider Business Practice Location Address
First Line : 700 WASHINGTON AVE STE 200
Second Line :
City : GRAND HAVEN
State : MI
Zip : 49417-1462
Country : US
Telephone Number : 616-842-6710
Fax Number : 616-842-1103
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2023
Last Update Date : 07/31/2023

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