Hansen, Tracie Lyn

Hansen, Tracie Lyn is an sole proprietor health care provider with primary practice located at 560 Fairway Dr , Pocatello ID 83201-2012. She recently has only one registered license in Other Service Providers / Peer Specialist, which is considered as her primary health care specialty. Hansen, Tracie Lyn can be contacted via phone (208) 242-6669.

Contact Information

Primary practice address
560 Fairway Dr Pocatello ID 83201-2012
Phone: (208) 242-6669
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Peer Specialist 175T00000X CPSS055 Idaho

Profile Details

NPI number 1639779523
LBN Legal business name Hansen, Tracie Lyn
Credentials B.S.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 29th, 2020
Last updated Apr 10th, 2023 - about 2 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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