Active NPI
Traci Jo Drake, MASTERS LTD SOC WORK
- Social Worker
- Hartford, MI
National Provider Identifier
1447445697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6801088698
- Practice address
- 57150 CR 681
Hartford, MI 49057 - Phone
- (269) 621-2800
- Fax
- (269) 621-2962
- NPI assigned
- Sep 11, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6801088698 | MI | Primary |
Addresses
Primary practice location
57150 CR 681
Hartford, MI 49057
Mailing address
PO Box 249
801 Hazen Street Suite C
Paw Paw, MI 49079-0249
Phone (269) 657-5574
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6801088698 | MI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189468800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189468800000",
"number": "1447445697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 249",
"address_2": "801 HAZEN STREET SUITE C",
"city": "PAW PAW",
"state": "MI",
"postal_code": "490790249",
"telephone_number": "269-657-5574",
"fax_number": "269-657-3474"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "57150 CR 681",
"city": "HARTFORD",
"state": "MI",
"postal_code": "49057",
"telephone_number": "269-621-2800",
"fax_number": "269-621-2962"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRAKE",
"first_name": "TRACI",
"middle_name": "JO",
"name_prefix": "Ms.",
"credential": "MASTERS LTD SOC WORK",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-11",
"last_updated": "2007-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6801088698",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hartford, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.