TRACIE LYN HANSEN (NPI# 1639779523) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639779523 |
| Entity Type | Individual |
| Full Name | TRACIE LYN HANSEN |
| Other Name | TRACIE LYN BURRUP |
| Credential | B.S. |
| Practice Address |
560 Fairway Dr Pocatello ID 83201-2012 |
| Practice Telephone | 2082426669 |
| Mailing Telephone | 2082426669 |
| Enumeration Date | 2020-10-29 |
| Last Update Date | 2020-10-29 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | CPSS055 | ID | Other Service Providers |
| Street Address |
560 FAIRWAY DR |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201-2012 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235765330 | Timothy Palmer | Social Worker | 400 S 11th Ave, Ste 204, Pocatello, ID 83201 | 2020-03-20 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1659935195 | Carol Jane Dillon | Counselor | 707 North 7th Avenue, Suite D, Pocatello, ID 83201 | 2019-04-30 |
| 1154801595 | Mv Pocatello Ent, LLC | Otolaryngology | 333 N 18th Ave Ste B3, Pocatello, ID 83201 | 2018-08-15 |
| 1306344346 | Ruth Anne Patton | Social Worker | 850 E Young St, Pocatello, ID 83201 | 2018-01-24 |
| 1598289274 | Lucas Alexander Bryan | Specialist/Technologist | 1535 E Terry St, Pocatello, ID 83201 | 2017-08-03 |
| 1205365632 | Geno Alan Giovanini | Denturist | 115 S. 15th Ave. Ste. D, Pocatello, ID 83201 | 2017-06-08 |
| 1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
| 1346797842 | Shailyn Jenkins | Specialist/Technologist | 665 Warren Ave., Pocatello, ID 83201 | 2016-09-01 |
| 1992258149 | Christopher Jared White | Social Worker | 300 N 7th Ave, Pocatello, ID 83201 | 2016-07-24 |
| Find all providers in zip 83201 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184113482 | Kolleen Marie Wynn-gallipeau | Peer Specialist | 444 Hospital Way Ste 447, Pocatello, ID 83201-2744 | 2018-05-02 |
| 1750887394 | Shawn Grischkowsky | Peer Specialist | 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 | 2018-04-03 |
| 1760980023 | Lisa Gay Johnston | Peer Specialist | 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 | 2018-01-31 |
| 1811417272 | Lauren Elizabeth Ellsworth | Peer Specialist | 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 | 2017-06-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306481817 | Ability Health and Rehabilitation LLC | Peer Specialist | 10101 W Overland Rd Ste 110, Boise, ID 83709-1429 | 2019-11-08 |
| 1609426923 | Amie Hughes | Peer Specialist | 4737 S Afton Pl Ste A, Chubbuck, ID 83202-2317 | 2019-09-18 |
| 1073127791 | Calm Waters Counseling Pllc | Peer Specialist | 10108 W Overland Rd Ste A, Boise, ID 83709-1428 | 2020-09-01 |
| 1790307890 | Jx2 LLC | Peer Specialist | 8950 W Emerald St Ste 178, Boise, ID 83704-8296 | 2020-05-12 |
| 1063034437 | Inroads, Inc | Peer Specialist | 3288 E Pine Ave, Meridian, ID 83642-5922 | 2020-05-08 |
| 1356962112 | Aaa American Healthcare LLC | Peer Specialist | 1301 E 17th St, Idaho Falls, ID 83404-6273 | 2020-05-04 |
| 1346878691 | Aspen Ministries Syringa Wellness | Peer Specialist | 1609 S Kimball Ave Ste 200, Caldwell, ID 83605-5196 | 2020-03-31 |
| 1962033399 | Lookout Behavioral Health LLC | Peer Specialist | 7905 N Meadowlark Way Ste A, Coeur D Alene, ID 83815-5041 | 2020-02-04 |
| 1356981419 | Lake City Counseling Center | Peer Specialist | 9705 N Shaw St, Hayden, ID 83835-9716 | 2020-01-07 |
| 1700425600 | Center Counseling, LLC | Peer Specialist | 265 E Chubbuck Rd, Chubbuck, ID 83202-5055 | 2019-12-26 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on TRACIE LYN HANSEN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.