Individual
TRACI DEGRAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15002 N 32ND ST, PHOENIX, AZ 85032-4441
(602) 787-5001
Mailing address
15002 N 32ND ST, PHOENIX, AZ 85032-4441
(602) 787-5001
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-11450
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
105065
AHCCCS PROVIDER NUMBER
AZ
Enumeration date
12/11/2006
Last updated
07/08/2007
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