Most Relevant Information
Provider Data
| NPI Number: | 1003259193 |
| Provider Name: | TRACY MADDOX |
| Entity Type: | Individual |
| Taxonomy Code: | 104100000X |
| Specialty: | Social Worker |
| License Number: | 68030385984 |
Most Important Dates
| Enumeration Date: | 04/09/2013 |
| Last Updated: | 04/09/2013 |
Provider Practice Location
5303 S CEDAR ST
LANSING
MI
489113800
Practice Location Phone/Fax
| Phone: | 5173468017 |
| Fax: |
Provider Mailing Location
812 E JOLLY RD
SUITE 210
LANSING
MI
489106818
Provider Mailing Phone/Fax
| Phone: | 5173468200 |
| Fax: |