Provider Demographics
NPI:1780747204
Name:RIEGERT, TRACEY (MSW)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:RIEGERT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 W ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53219-2468
Mailing Address - Country:US
Mailing Address - Phone:414-546-1751
Mailing Address - Fax:
Practice Address - Street 1:7720 W ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53219-2468
Practice Address - Country:US
Practice Address - Phone:414-546-1751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI658-122104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker