Individual
TRACY R DERICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1272 WOLFHOUND ST, TIMNATH, CO 80547-4488
(970) 231-0341
Mailing address
1055 SOUTH ST, WHEATLAND, WY 82201-2949
(307) 331-7899
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
WY
Other
Enumeration date
04/15/2025
Last updated
04/15/2025
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