Provider Demographics
NPI:1427243369
Name:PRITZL, TRACY RENEE (PSYD, BCBA-D)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:RENEE
Last Name:PRITZL
Suffix:
Gender:F
Credentials:PSYD, BCBA-D
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:RENEE
Other - Last Name:BREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:3636 N 124TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222
Mailing Address - Country:US
Mailing Address - Phone:414-476-9755
Mailing Address - Fax:414-476-3413
Practice Address - Street 1:3636 N 124TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222
Practice Address - Country:US
Practice Address - Phone:414-476-9755
Practice Address - Fax:414-476-3413
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44-140103K00000X
WI2825-27103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1427243369Medicaid