Provider Demographics
NPI:1003066861
Name:TRACZEWITZ, JILL (MS, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:TRACZEWITZ
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 TEXAS AVE
Mailing Address - Street 2:SUITE 3061
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3944
Mailing Address - Country:US
Mailing Address - Phone:318-443-8380
Mailing Address - Fax:318-443-6079
Practice Address - Street 1:2108 TEXAS AVE
Practice Address - Street 2:SUITE 3061
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3944
Practice Address - Country:US
Practice Address - Phone:318-443-8380
Practice Address - Fax:318-443-6079
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5745237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter