| Doctor Name: | MISS TRACY ANN KUBIAK |
| NPI Number: | 1366581837 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS |
| License Number: | |
| Business Practice Address: | 346 Alana Dr New Lenox, IL - 604511784 |
| Business Phone Number: | 8154620514 |
| Business Fax Number: | 8154623993 |
| Mailing Address: | 9030 West 174th Street, TINLEY PARK |
| State: | IL |
| Postal Code: | 60487 |
| Phone Number: | 7084295278 |
| Fax Number: | 7084294020 |
| NPI Enumeration Date: | 02/05/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | |
| 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 |