Individual
TRACY J LONGTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICENSED PROFESSIONA
Contact information
Practice address
1531 S MADISON ST, APPLETON, WI 54915-1800
(920) 730-4411
Mailing address
1531 S MADISON ST, APPLETON, WI 54915-1800
(920) 730-4411
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3279125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40973400
—
WI
Enumeration date
09/28/2005
Last updated
07/08/2007
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