Provider Demographics
NPI:1275921322
Name:SPRINGER, TRACY DENISE (SAC)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:DENISE
Last Name:SPRINGER
Suffix:
Gender:F
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ATLAS AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-3181
Mailing Address - Country:US
Mailing Address - Phone:608-223-0017
Mailing Address - Fax:608-223-0019
Practice Address - Street 1:903 N 2ND ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4702
Practice Address - Country:US
Practice Address - Phone:715-848-3202
Practice Address - Fax:715-848-2404
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15814-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)