Individual
ANTONIA TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12360 CREEK RUN DR APT M, SAINT LOUIS, MO 63141-6579
(314) 706-1842
Mailing address
6143 VIRGINIA AVE, SAINT LOUIS, MO 63111-2431
(309) 370-5992
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/23/2021
Last updated
09/23/2021
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