Most Relevant Information
Provider Data
| NPI Number: | 1003437765 |
| Provider Name: | TRACIE HEACOX |
| Entity Type: | Individual |
| Taxonomy Code: | 103K00000X |
| Specialty: | Behavior Analyst |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/04/2020 |
| Last Updated: | 05/04/2020 |
Provider Practice Location
6200 BURY DR
EDEN PRAIRIE
MN
553461718
Practice Location Phone/Fax
| Phone: | 8668227464 |
| Fax: |
Provider Mailing Location
6128 PENN AVE S
MINNEAPOLIS
MN
554192035
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |