| NPI | 1225166135 |
|---|---|
| Former Name | TRACI LYN WEISE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MN 15625) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 9015-123) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2024-06-04 |