| Doctor Name: | MRS. TRACI B FREDMAN |
| NPI Number: | 1235387184 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS,CCC-SLP |
| License Number: | 101972 |
| Business Practice Address: | 2501 4th Ave Canyon, TX - 790160001 |
| Business Phone Number: | 8066515101 |
| Business Fax Number: | 8066515105 |
| Mailing Address: | Wtamu Box 60757, CANYON |
| State: | TX |
| Postal Code: | 790160001 |
| Phone Number: | 8066515101 |
| Fax Number: | 8066515105 |
| NPI Enumeration Date: | 09/04/2008 |
| NPI Last Update Date: | 01/29/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 101972 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| 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 |