Provider Demographics
NPI:1235977976
Name:LEGROW, TRACY LYNN (MA)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:LEGROW
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-1204
Mailing Address - Country:US
Mailing Address - Phone:574-376-3018
Mailing Address - Fax:
Practice Address - Street 1:105 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-1204
Practice Address - Country:US
Practice Address - Phone:574-268-0448
Practice Address - Fax:574-549-9039
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health