Doctor Name: | PATRICIA J TRACY |
NPI Number: | 1295864064 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S., CCC-SLP |
License Number: | 146003318 |
Business Practice Address: | 7a Ginger Creek Village Drive Glen Carbon, IL - 620344916 |
Business Phone Number: | 6186567157 |
Business Fax Number: | 6186560026 |
Mailing Address: | 7a Ginger Creek Village Drive, GLEN CARBON |
State: | IL |
Postal Code: | 620340188 |
Phone Number: | 6186567157 |
Fax Number: | 6786560266 |
NPI Enumeration Date: | 03/05/2007 |
NPI Last Update Date: | 03/23/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 146003318 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
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 |