Tracie Anderson, L.I.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

3058 Issued in MN

Practice address

45 10TH St W
Saint Paul, MN 55102-1062

Phone

(651) 232-3801

NPI assigned

Nov 22, 2013

Last updated

Nov 22, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Tracie Ann Benson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1385078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385078400000",
    "number": "1548690902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 10TH ST W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551021062",
            "telephone_number": "651-232-3801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 10TH ST W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551021062",
            "telephone_number": "651-232-3801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "TRACIE",
        "credential": "L.I.C.S.W.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-22",
        "last_updated": "2013-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "3058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACIE",
            "last_name": "BENSON",
            "middle_name": "ANN",
            "credential": "LICSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sarah Elizabeth Anderson, LICSW
• Stephanie R Anderson, MD
• Steven Duane Anderson, MD
• Susan C Anderson, DDS
• Thomas R Anderson, CRNA
• Vicki M Anderson, MA
• Yvette Anderson
• Elizabeth Andrade, LAMFT
• Nathaly Andrade
• James C Andrea, DDS

• Clinical Social Worker in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.