Provider Demographics
NPI:1588218689
Name:TRACY, LYNNAE NYCOLE
Entity Type:Individual
Prefix:
First Name:LYNNAE
Middle Name:NYCOLE
Last Name:TRACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYNNAE
Other - Middle Name:NYCOLE
Other - Last Name:TRACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5709 W SUNSET HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-9446
Mailing Address - Country:US
Mailing Address - Phone:509-209-2739
Mailing Address - Fax:
Practice Address - Street 1:5709 W SUNSET HWY STE 101
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-9446
Practice Address - Country:US
Practice Address - Phone:509-209-2739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician