Provider Demographics
NPI:1104615376
Name:MAKOWSKI, TRACEY
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:MAKOWSKI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-3937
Mailing Address - Country:US
Mailing Address - Phone:734-252-5215
Mailing Address - Fax:734-822-0237
Practice Address - Street 1:1122 WALNUT ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-3937
Practice Address - Country:US
Practice Address - Phone:734-252-5215
Practice Address - Fax:734-822-0237
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician