Individual
MRS. TRACI LEE HACKMANN BATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA LP
Contact information
Practice address
3920 SIBLEY MEMORIAL HWY, EAGAN, MN 55122-1414
(651) 681-0616
(651) 681-0747
Mailing address
4481 PONDVIEW TRL SE, PRIOR LAKE, MN 55372-2987
(952) 440-1578
(651) 994-7440
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP3650
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123175
UCARE
MN
01
—
454T7HA
BLUE CROSS BLUE SHIELD
MN
01
—
62-64083
UBH
MN
01
—
HP24216
HEALTHPARTNERS
MN
Enumeration date
08/30/2006
Last updated
07/08/2007
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