| NPI | 1689601049 |
|---|---|
| Former Name | TRACY LYNN ANDERSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C006324) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904006508) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2010-07-09 |