Provider Demographics
NPI:1700329281
Name:MUNTZ-DALTON, TRACY KATHERIN
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:KATHERIN
Last Name:MUNTZ-DALTON
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 1:2000 NOBLE DR
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-5353
Mailing Address - Country:US
Mailing Address - Phone:330-202-3866
Mailing Address - Fax:330-202-3883
Practice Address - Street 1:2000 NOBLE DR
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-5353
Practice Address - Country:US
Practice Address - Phone:330-202-3866
Practice Address - Fax:330-202-3883
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI13028151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical