Provider Demographics
NPI:1245470863
Name:ACKER, TRACY RENEE (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:RENEE
Last Name:ACKER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 HIGHWAY 15 S
Mailing Address - Street 2:STE 200
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-3506
Mailing Address - Country:US
Mailing Address - Phone:320-587-4127
Mailing Address - Fax:320-587-3886
Practice Address - Street 1:902 HIGHWAY 15 S
Practice Address - Street 2:STE 200
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-3506
Practice Address - Country:US
Practice Address - Phone:320-587-4127
Practice Address - Fax:320-587-3886
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-22
Last Update Date:2009-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical