Provider Demographics
NPI:1912430828
Name:DESCHAMPE SAGE, TRACY MARIE
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:MARIE
Last Name:DESCHAMPE SAGE
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 1:102 N MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-1706
Mailing Address - Country:US
Mailing Address - Phone:307-461-3392
Mailing Address - Fax:
Practice Address - Street 1:102 N MONTANA AVE
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-1706
Practice Address - Country:US
Practice Address - Phone:307-461-3392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator