Kellam, Tracy
Kellam, Tracy is an sole proprietor health care provider with primary practice located at 4120 Euclid Blvd , Youngstown OH 44512-1305. She recently has only one registered license in Other Service Providers / Contractor, which is considered as her primary health care specialty. Kellam, Tracy can be contacted via phone (330) 984-1505.Contact Information
Primary practice address
4120 Euclid Blvd
Youngstown OH 44512-1305
Phone: (330) 984-1505
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Contractor | 171W00000X | 0325993 | Ohio |
Profile Details
| NPI number | 1104498344 |
|---|---|
| LBN Legal business name | Kellam, Tracy |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 16th, 2021 |
| Last updated | Jul 16th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104498344 | NPPES |
| Ohio | MEDICAID | 0325993 |
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