Provider Demographics
NPI:1114061348
Name:TRAGER, DENNISE LINDA (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:DENNISE
Middle Name:LINDA
Last Name:TRAGER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 MOBILE DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-9021
Mailing Address - Country:US
Mailing Address - Phone:541-488-2264
Mailing Address - Fax:
Practice Address - Street 1:255 MOBILE DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-9021
Practice Address - Country:US
Practice Address - Phone:541-488-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL40831041C0700X
CT0031351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R160516OtherMEDICARE PTAN