Provider Demographics
NPI:1972200947
Name:STILLMAN, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:STILLMAN
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 1:1605 POTAWATOMI LN APT 2
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-7042
Mailing Address - Country:US
Mailing Address - Phone:812-841-9116
Mailing Address - Fax:
Practice Address - Street 1:8 MORGAN BLVD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4836
Practice Address - Country:US
Practice Address - Phone:219-525-1737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker