Individual
TRACY ANN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2510 E CAPITOL DR, SHOREWOOD, WI 53211-2136
(414) 975-8106
Mailing address
2510 E CAPITOL DR, SHOREWOOD, WI 53211-2136
(414) 975-8106
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
131056-121
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417629668
—
WI
Enumeration date
10/05/2021
Last updated
05/02/2025
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