| Doctor Name: | AUDRA TRACEY |
| NPI Number: | 1124488531 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 1701 |
| Business Practice Address: | 17809 Pierce Plz Children's Rehab Speech Therapy Omaha, NE - 681301035 |
| Business Phone Number: | 4029558355 |
| Business Fax Number: | 4029558356 |
| Mailing Address: | 8200 Dodge St, Children's Hospital & Medical Center OMAHA |
| State: | NE |
| Postal Code: | 681144113 |
| Phone Number: | 4029555400 |
| Fax Number: | |
| NPI Enumeration Date: | 02/26/2016 |
| NPI Last Update Date: | 02/26/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 1701 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NE |
| 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 |