Doctor Name: | MICHELLE RENEE TRACEY |
NPI Number: | 1124365937 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A., CCC-SLP |
License Number: | 744 |
Business Practice Address: | 315 E Queen St Pendleton, SC - 296701721 |
Business Phone Number: | 8644032309 |
Business Fax Number: | |
Mailing Address: | 315 E Queen St, PENDLETON |
State: | SC |
Postal Code: | 296701721 |
Phone Number: | 8644032309 |
Fax Number: | |
NPI Enumeration Date: | 01/14/2013 |
NPI Last Update Date: | 09/24/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 744 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |