Provider Demographics
NPI:1720587280
Name:REETZ, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:REETZ
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 1:22500 METRO PKWY STE 403
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-1904
Mailing Address - Country:US
Mailing Address - Phone:586-741-4142
Mailing Address - Fax:
Practice Address - Street 1:22500 METRO PKWY STE 403
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-1904
Practice Address - Country:US
Practice Address - Phone:586-741-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020580381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical