Provider Demographics
NPI:1306569769
Name:MAESSE, TRACY LYNN (LMSW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:MAESSE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:MAESSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:1202 WESTRAC DRIVE SUITE 400
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103
Mailing Address - Country:US
Mailing Address - Phone:701-595-3904
Mailing Address - Fax:
Practice Address - Street 1:1202 WESTRAC DRIVE SUITE 400
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103
Practice Address - Country:US
Practice Address - Phone:701-595-3904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ND6620104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator