Provider Demographics
NPI:1922570670
Name:TRAMMELL, IDA (MSW)
Entity type:Individual
Prefix:
First Name:IDA
Middle Name:
Last Name:TRAMMELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:IDA
Other - Middle Name:
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:8503 WHITES CRK
Mailing Address - Street 2:
Mailing Address - City:CATLETTSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41129-8921
Mailing Address - Country:US
Mailing Address - Phone:304-521-3546
Mailing Address - Fax:304-501-1860
Practice Address - Street 1:8503 WHITES CRK
Practice Address - Street 2:
Practice Address - City:CATLETTSBURG
Practice Address - State:KY
Practice Address - Zip Code:41129-8921
Practice Address - Country:US
Practice Address - Phone:304-521-3546
Practice Address - Fax:304-501-1860
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2512671104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker