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Individual
MISS TRACY TREDENNICK
Active
Individual
MISS TRACY TREDENNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CW015802
PA
208000000X
Pediatrics Physician
CW105802
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007708200003
—
PA
05
—
1025856980001
—
PA
Enumeration date
02/29/2008
Last updated
09/02/2011
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