Individual
TRACY KELLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4120 EUCLID BLVD, YOUNGSTOWN, OH 44512-1305
(330) 984-1505
Mailing address
4120 EUCLID BLVD, YOUNGSTOWN, OH 44512-1305
(330) 984-1505
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
0325993
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0325993
—
OH
Enumeration date
07/16/2021
Last updated
07/16/2021
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