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Individual
TRACIE L ANDERSON
Active
Individual
TRACIE L ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34000315A
IN
1041C0700X
Clinical Social Worker
807
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000056294
ANTHEM GROUP
—
01
—
000000226075
ANTHEM
—
01
—
100386460
INDIANA MEDICAID GROUP
IN
01
—
1518960681
DR BUTLER'S NPI
—
01
—
160780
MEDICARE GROUP
IN
01
—
160860
MEDICARE GROUP
IN
05
—
200319860A
—
IN
01
—
2444451000
PASSPORT GROUP
KY
01
—
264003000
BR BUTLER'S MIS
—
01
—
2767013000
PASSPORT ADVANTAGE
KY
01
—
50704000
MAGELLAN GROUP MIS
—
01
—
65927857
MEDICAID KENTUCKY GROUP
KY
01
—
78903689
MEDICAID KENTUCKY GROUP
KY
01
—
800012510
MEDICARE RAILROAD
IN
05
—
8200076100
—
KY
01
—
82900176
MEDICAID KENTUCKY GROUP
KY
01
—
94882000
MAGELLAN MIS
—
01
—
CG3623
INDIANA RAILROAD MEDICARE
IN
Enumeration date
05/24/2005
Last updated
08/15/2015
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