Provider Demographics
NPI:1962761262
Name:ATKINSON, TRACEY L (MS)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:L
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 S MAIN ST APT 105
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53531-9413
Mailing Address - Country:US
Mailing Address - Phone:608-898-3154
Mailing Address - Fax:
Practice Address - Street 1:199 COUNTY ROAD DF FL 3
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:WI
Practice Address - Zip Code:53039-9512
Practice Address - Country:US
Practice Address - Phone:920-386-3816
Practice Address - Fax:920-386-4564
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1270-226101YP2500X
WI5864-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional