MEDICARE: TRACIE HEWITT MA, LEP #4031

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	103TS0200X	School Psychologist	4031	CA

General Provider Information

NPI Number	:	1790555878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACIE HEWITT MA, LEP #4031

Provider Business Mailing Address
First Line	:	4811 CHIPPENDALE DR STE 501
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95841-2553
Country	:	US
Telephone Number	:	916-834-8096
Fax Number	:

Provider Business Practice Location Address
First Line	:	4811 CHIPPENDALE DR STE 501
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95841-2553
Country	:	US
Telephone Number	:	916-834-8096
Fax Number	:

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

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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