Provider Demographics
NPI:1841083771
Name:SUTLIFF, TRACIE JO
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:JO
Last Name:SUTLIFF
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 1:330 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2148
Mailing Address - Country:US
Mailing Address - Phone:517-788-9147
Mailing Address - Fax:
Practice Address - Street 1:330 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2148
Practice Address - Country:US
Practice Address - Phone:517-788-9147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist