MEDICARE: TRACY CROCKETT

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1629932694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY CROCKETT

Provider Business Mailing Address
First Line	:	1446 MANCHESTER RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44314-3358
Country	:	US
Telephone Number	:	330-926-7591
Fax Number	:

Provider Business Practice Location Address
First Line	:	1446 MANCHESTER RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44314-3358
Country	:	US
Telephone Number	:	330-926-7591
Fax Number	:

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

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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Directions to “ TRACY CROCKETT ” Practice Location

Language	Start Address	Practice Location

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