Provider Demographics
NPI:1467243865
Name:LAIRD, TRACEE JOLENE
Entity type:Individual
Prefix:
First Name:TRACEE
Middle Name:JOLENE
Last Name:LAIRD
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 1:14071 PEYTON DR
Mailing Address - Street 2:# 1961
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1172
Mailing Address - Country:US
Mailing Address - Phone:626-319-0806
Mailing Address - Fax:
Practice Address - Street 1:14071 PEYTON DR
Practice Address - Street 2:# 1961
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1172
Practice Address - Country:US
Practice Address - Phone:626-319-0806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA264131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical