Provider Demographics
NPI:1881137891
Name:FROSTICK, TRACY (MSW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:FROSTICK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LEE
Other - Last Name:HADERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 MONROE AVE NW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:800-600-4096
Mailing Address - Fax:800-606-8839
Practice Address - Street 1:201 MONROE AVE NW
Practice Address - Street 2:SUITE 300
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2212
Practice Address - Country:US
Practice Address - Phone:800-600-4096
Practice Address - Fax:800-606-8839
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010966141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical