Provider Demographics
NPI:1417197583
Name:VANDEN HEUVEL, TRACY LEE (LCSW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LEE
Last Name:VANDEN HEUVEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 S IOWA ST
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1720
Mailing Address - Country:US
Mailing Address - Phone:608-935-9235
Mailing Address - Fax:608-935-9044
Practice Address - Street 1:6314 ODANA RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1129
Practice Address - Country:US
Practice Address - Phone:608-277-0610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7459-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical