Provider Demographics
NPI:1760979280
Name:ZELLNER, TRACI M
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:M
Last Name:ZELLNER
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 1:780 PARK AVE W STE D
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-3009
Mailing Address - Country:US
Mailing Address - Phone:419-709-8103
Mailing Address - Fax:419-709-8132
Practice Address - Street 1:780 PARK AVE W STE D
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-3009
Practice Address - Country:US
Practice Address - Phone:419-709-8103
Practice Address - Fax:419-709-8132
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker