Provider Demographics
NPI:1083737316
Name:TRAGER, JILL E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:E
Last Name:TRAGER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 ASHMAN ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4434
Mailing Address - Country:US
Mailing Address - Phone:989-832-1884
Mailing Address - Fax:
Practice Address - Street 1:2719 ASHMAN ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4434
Practice Address - Country:US
Practice Address - Phone:989-832-1884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI009739103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI009739OtherSTATE LICENSE
MI53970Medicare UPIN
MI0N53970Medicare ID - Type Unspecified