Provider Demographics
NPI:1780010660
Name:KLEVE, TRACI ANN (MS, RD, LD,CDE)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:ANN
Last Name:KLEVE
Suffix:
Gender:F
Credentials:MS, RD, LD,CDE
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:ANN
Other - Last Name:HARMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,RD,LD,CDE
Mailing Address - Street 1:2930 ROANOKE ST NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-2846
Mailing Address - Country:US
Mailing Address - Phone:330-338-2756
Mailing Address - Fax:
Practice Address - Street 1:2930 ROANOKE ST NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-2846
Practice Address - Country:US
Practice Address - Phone:330-338-2756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH914164133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered