Provider Demographics
NPI:1073828331
Name:YONKMAN, TRACIE MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:MICHELLE
Last Name:YONKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TRACIE
Other - Middle Name:MICHELLE
Other - Last Name:GOSSETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1255 W COLTON AVE STE 122
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2861
Mailing Address - Country:US
Mailing Address - Phone:909-441-1841
Mailing Address - Fax:909-363-2935
Practice Address - Street 1:1255 W COLTON AVE STE 122
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2861
Practice Address - Country:US
Practice Address - Phone:909-991-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98664106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist