Provider Demographics
NPI:1568178309
Name:MASON, TRACEY LEANNE
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LEANNE
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 BELLO VEDERE AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-9391
Mailing Address - Country:US
Mailing Address - Phone:304-280-0862
Mailing Address - Fax:
Practice Address - Street 1:111 PARK VIEW LN
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5493
Practice Address - Country:US
Practice Address - Phone:304-280-0862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator