Daniels, Tracy

Daniels, Tracy is an individual health care provider with primary practice located at 1717 Taylor Ave , Racine WI 53403-2405. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is her primary health care specialty. Daniels, Tracy can be contacted via phone (262) 638-6674.

Contact Information

Primary practice address
1717 Taylor Ave Racine WI 53403-2405
Phone: (262) 638-6674
Fax: (262) 638-6540
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 11389 Wisconsin
Behavioral Health & Social Service Providers / Professional 101YP2500X 8036 Wisconsin

Profile Details

NPI number 1114460268
LBN Legal business name Daniels, Tracy
Credentials CSAC, LPC, ICS
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 22nd, 2016
Last updated Jul 26th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114460268 NPPES
Wisconsin MEDICAID 10062879

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