Provider Demographics
NPI:1144015983
Name:WILSON RINERSON, TRACY MICHELLE
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:MICHELLE
Last Name:WILSON RINERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45915 RIVER LOOP RD
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:OR
Mailing Address - Zip Code:97358-9517
Mailing Address - Country:US
Mailing Address - Phone:805-688-4400
Mailing Address - Fax:
Practice Address - Street 1:238 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2857
Practice Address - Country:US
Practice Address - Phone:541-791-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25-CRM-4123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker