Provider Demographics
NPI:1922570670
Name:TRAMMELL, IDA (BSW)
Entity type:Individual
Prefix:
First Name:IDA
Middle Name:
Last Name:TRAMMELL
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:IDA
Other - Middle Name:
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:424 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1474
Mailing Address - Country:US
Mailing Address - Phone:740-533-0055
Mailing Address - Fax:740-533-1511
Practice Address - Street 1:424 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1474
Practice Address - Country:US
Practice Address - Phone:740-533-0055
Practice Address - Fax:740-533-1511
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker