Provider Demographics
NPI:1790922748
Name:BLAUSER, TRACY C
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:C
Last Name:BLAUSER
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 1:5500 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-3700
Mailing Address - Country:US
Mailing Address - Phone:262-564-0067
Mailing Address - Fax:262-652-1411
Practice Address - Street 1:5500 8TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-3700
Practice Address - Country:US
Practice Address - Phone:262-564-0067
Practice Address - Fax:262-652-1411
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator