Provider Demographics
NPI:1235295890
Name:ANDERSON, TRACEE LYN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TRACEE
Middle Name:LYN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E. BROADWAY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4510
Mailing Address - Country:US
Mailing Address - Phone:406-214-5133
Mailing Address - Fax:
Practice Address - Street 1:101 E. BROADWAY
Practice Address - Street 2:SUITE 310
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4510
Practice Address - Country:US
Practice Address - Phone:406-214-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000070691041C0700X
MT426621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical