MEDICARE: TRACY LYNN WINBORN

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.194877	OH

General Provider Information

NPI Number	:	1780479840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY LYNN WINBORN

Provider Business Mailing Address
First Line	:	6192 JAYCOX RD
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-1606
Country	:	US
Telephone Number	:	440-309-8698
Fax Number	:	440-309-8698

Provider Business Practice Location Address
First Line	:	6192 JAYCOX RD
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-1606
Country	:	US
Telephone Number	:	440-309-8698
Fax Number	:	440-309-8698

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

Provider Enumeration Date	:	04/10/2025
Last Update Date	:	01/20/2026

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Directions to “ TRACY LYNN WINBORN ” Practice Location

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