Provider Demographics
NPI:1841204161
Name:CHENETTE, TRACI (LCSW)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:CHENETTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4010
Mailing Address - Country:US
Mailing Address - Phone:541-517-9733
Mailing Address - Fax:888-971-3877
Practice Address - Street 1:6018 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1990
Practice Address - Country:US
Practice Address - Phone:541-517-9733
Practice Address - Fax:888-971-3877
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0426011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500679132Medicaid