Provider Demographics
NPI:1982830121
Name:BROWN, TRACI L (LPC)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:L
Other - Last Name:VAN REMORTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W6240 COMMUNICATION CT STE 2
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-8549
Mailing Address - Country:US
Mailing Address - Phone:920-364-0747
Mailing Address - Fax:
Practice Address - Street 1:W6240 COMMUNICATION CT STE 2
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-8549
Practice Address - Country:US
Practice Address - Phone:920-364-0747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4053101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40930300Medicaid