Individual
TRACY MIRACLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1005 S GLENDALE ST, WICHITA, KS 67218-3203
(316) 771-7315
Mailing address
1005 S GLENDALE ST, WICHITA, KS 67218-3203
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
12283
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12283
BSRB
KS
Enumeration date
04/05/2022
Last updated
04/05/2022
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