Provider Demographics
NPI:1316341340
Name:SCHICKLEY, TRACEY
Entity type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:
Last Name:SCHICKLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-1770
Mailing Address - Country:US
Mailing Address - Phone:570-356-2420
Mailing Address - Fax:
Practice Address - Street 1:240 MARKET ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1770
Practice Address - Country:US
Practice Address - Phone:570-356-2420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator