Individual
KAISHA TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
6425 NICOLLET AVE, RICHFIELD, MN 55423-1675
(612) 861-1675
(612) 861-3446
Mailing address
6425 NICOLLET AVE, RICHFIELD, MN 55423-1675
(612) 861-1675
(612) 861-3446
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
25914
MN
Other
Enumeration date
10/02/2019
Last updated
03/17/2023
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