Provider Demographics
NPI:1750041596
Name:ROAT, TRACEY LYNNE (RSST)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNNE
Last Name:ROAT
Suffix:
Gender:F
Credentials:RSST
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:LYNNE
Other - Last Name:WESTENDORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1515 ALLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-4403
Mailing Address - Country:US
Mailing Address - Phone:989-860-2781
Mailing Address - Fax:
Practice Address - Street 1:2700 W GENESEE AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3723
Practice Address - Country:US
Practice Address - Phone:989-799-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803086673104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker