Provider Demographics
NPI:1245381086
Name:VOSDOGANES, TRACY K (LISW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:K
Last Name:VOSDOGANES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 HUNT RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6612
Mailing Address - Country:US
Mailing Address - Phone:513-891-0650
Mailing Address - Fax:513-891-2838
Practice Address - Street 1:1080 NIMITZVIEW DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4314
Practice Address - Country:US
Practice Address - Phone:513-688-7555
Practice Address - Fax:513-688-0591
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0004907104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH192636000OtherMAGELLAN PROVIDER NUMBER
OH311705723OtherEIN