Provider Demographics
NPI:1457040321
Name:WHISENTON, TRACY MICHELLE
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:MICHELLE
Last Name:WHISENTON
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 1:5501 DELMAR BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-3054
Mailing Address - Country:US
Mailing Address - Phone:314-302-0286
Mailing Address - Fax:
Practice Address - Street 1:5501 DELMAR BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-3054
Practice Address - Country:US
Practice Address - Phone:314-302-0286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical