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Individual
TRACIE L KELLOGG
Active
Individual
TRACIE L KELLOGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDCA
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
CDCA.174078
OH
171M00000X
Case Manager/Care Coordinator
Primary
CDCA.178035
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0411304
—
OH
Enumeration date
07/23/2020
Last updated
08/31/2021
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