Provider Demographics
NPI:1699977009
Name:THORSEN, TRACY J (LCSW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:J
Last Name:THORSEN
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 1:221 W SEMINARY ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-2358
Mailing Address - Country:US
Mailing Address - Phone:608-649-5792
Mailing Address - Fax:608-647-6611
Practice Address - Street 1:221 W SEMINARY ST
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-2358
Practice Address - Country:US
Practice Address - Phone:608-649-5792
Practice Address - Fax:608-647-6611
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39595300Medicaid