Provider Demographics
NPI:1699290262
Name:ZION, TRACEY L (LISW)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:L
Last Name:ZION
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 KY HIGHWAY 185
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-3302
Mailing Address - Country:US
Mailing Address - Phone:513-532-4056
Mailing Address - Fax:
Practice Address - Street 1:11100 KY HIGHWAY 185
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-3302
Practice Address - Country:US
Practice Address - Phone:513-532-4056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1200905-SUPV101Y00000X, 1041C0700X
KY2544861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor