Provider Demographics
NPI:1376745943
Name:SIEMENS, TRACEY ANN (LCSW, MSW)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:ANN
Last Name:SIEMENS
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19914 S CABLE RD
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-3622
Mailing Address - Country:US
Mailing Address - Phone:816-322-5947
Mailing Address - Fax:
Practice Address - Street 1:19914 S CABLE RD
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-3622
Practice Address - Country:US
Practice Address - Phone:816-322-5947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050006261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical