Individual
CHARLES C TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
717 E RIVER PKWY, MINNEAPOLIS, MN 55455-0369
(612) 436-4800
(612) 436-2606
Mailing address
1281 RAYMOND AVE, SAINT PAUL, MN 55108-1817
(651) 644-4408
(612) 436-2606
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
01754
MN
Other
Enumeration date
10/12/2006
Last updated
07/08/2007
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