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Individual

TRACY L. NIELSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSW, LCSW

Contact information

Practice address
1100 N COLLEGE AVE, FAYETTEVILLE, AR 72703-1944
(479) 443-4301
Mailing address
PO BOX 2429, SMYRNA, TN 37167-1719

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
2017020602
MO
1041C0700X
Clinical Social Worker
Primary
2017020602
MO

Other

Enumeration date
06/17/2013
Last updated
09/23/2019
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