Provider Demographics
NPI:1295944791
Name:GILMORE, TRACY (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:GILMORE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 SW DOUGLAS ST # 23
Mailing Address - Street 2:
Mailing Address - City:MILL CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97360-0009
Mailing Address - Country:US
Mailing Address - Phone:773-332-3058
Mailing Address - Fax:
Practice Address - Street 1:478 SW DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:MILL CITY
Practice Address - State:OR
Practice Address - Zip Code:97360-0009
Practice Address - Country:US
Practice Address - Phone:773-332-3058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL102231041C0700X
IL149.0133221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical