Provider Demographics
NPI:1225892979
Name:DELGADO, TRACIE NICOLE
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:NICOLE
Last Name:DELGADO
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 1:124 3RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-5100
Mailing Address - Country:US
Mailing Address - Phone:509-754-2012
Mailing Address - Fax:
Practice Address - Street 1:124 3RD AVE SW
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-5100
Practice Address - Country:US
Practice Address - Phone:509-754-2012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health