| Doctor Name: | DR. TRACEY LYNN WALLACE |
| NPI Number: | 1144483033 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | AU.D., CCC/A |
| License Number: | 00718 |
| Business Practice Address: | 14101 Molly Berry Rd Brandywine, MD - 206132306 |
| Business Phone Number: | 3017933277 |
| Business Fax Number: | |
| Mailing Address: | 6368 Coventry Way, Suite #146 CLINTON |
| State: | MD |
| Postal Code: | 207352256 |
| Phone Number: | 3017933277 |
| Fax Number: | |
| NPI Enumeration Date: | 07/09/2008 |
| NPI Last Update Date: | 10/16/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 237600000X |
| License Number: | 00718 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Audiologist-Hearing Aid Fitter |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An audiologist/hearing aid fitter is the professional who specializes in evaluating and treating people with hearing loss, conducts a wide variety of tests to determine the exact nature of an individual |