Provider Demographics
NPI:1346659307
Name:PAGE, TRACI (MA LPCC LADC)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:MA LPCC LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5560 145TH CIR NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-5168
Mailing Address - Country:US
Mailing Address - Phone:763-458-2967
Mailing Address - Fax:763-260-5150
Practice Address - Street 1:200 5TH ST NW STE E
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-5711
Practice Address - Country:US
Practice Address - Phone:763-458-2967
Practice Address - Fax:763-260-5150
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303916101YA0400X
MN0311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)