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Individual

KERI ANN TRACY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MA, LBS

Contact information

Practice address
433 WAYNEBROOK DR, CHESTER SPRINGS, PA 19425-3843
(267) 307-5145
Mailing address
433 WAYNEBROOK DR, CHESTER SPRINGS, PA 19425-3843

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
BH000424
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
BH000424
LICENSED BEHAVIOR SPECIALIST
PA
Enumeration date
07/02/2014
Last updated
07/02/2014
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