Provider Demographics
NPI:1912144924
Name:DUTKO, TRACY LEE (MS)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LEE
Last Name:DUTKO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:LEE
Other - Last Name:TITUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:835 SCHOOLHOUSE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16613-6042
Mailing Address - Country:US
Mailing Address - Phone:814-312-3459
Mailing Address - Fax:814-942-9725
Practice Address - Street 1:615 HOWARD AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601
Practice Address - Country:US
Practice Address - Phone:814-312-3459
Practice Address - Fax:814-942-9725
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health