Provider Demographics
NPI:1235799412
Name:BOLYARD, TRACY ANN (MSW, LISW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:BOLYARD
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:ANN
Other - Last Name:BOLYARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:661 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44618-9439
Mailing Address - Country:US
Mailing Address - Phone:330-749-7009
Mailing Address - Fax:
Practice Address - Street 1:661 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:OH
Practice Address - Zip Code:44618-9439
Practice Address - Country:US
Practice Address - Phone:330-749-7009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHI.23042181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator