Provider Demographics
NPI:1689220162
Name:STEGH, TRACI LYNN
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LYNN
Last Name:STEGH
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 1:135 S EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-1513
Mailing Address - Country:US
Mailing Address - Phone:440-466-4831
Mailing Address - Fax:
Practice Address - Street 1:135 S EAGLE ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-1513
Practice Address - Country:US
Practice Address - Phone:440-466-4831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3311978103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool