| Doctor Name: | LAURA KORENSTRA TRACEY |
| NPI Number: | 1023273596 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 125 N Lake St Manistique, MI - 498541234 |
| Business Phone Number: | 9063415214 |
| Business Fax Number: | |
| Mailing Address: | 125 N Lake St, MANISTIQUE |
| State: | MI |
| Postal Code: | 498541234 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/24/2008 |
| NPI Last Update Date: | 07/24/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TB0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Cognitive & Behavioral |
| Taxonomy Definition: | |