Provider Demographics
NPI:1629474093
Name:GLOVER, TRACY SHOWANNA (MS, CLINICIAN I)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:SHOWANNA
Last Name:GLOVER
Suffix:
Gender:F
Credentials:MS, CLINICIAN I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E EARLL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2647
Mailing Address - Country:US
Mailing Address - Phone:602-599-5404
Mailing Address - Fax:602-599-5704
Practice Address - Street 1:262 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5932
Practice Address - Country:US
Practice Address - Phone:602-599-5698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator