Individual
MELISSA JENNIFER TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6601 COUNTY ROAD K, OMRO, WI 54963-9470
(920) 268-1998
Mailing address
1212 AUGUSTA WEST PKWY STE 1B, AUGUSTA, GA 30909-1808
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/27/2021
Last updated
05/27/2021
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