Provider Demographics
NPI:1003164237
Name:SANDERS, TRACY ANNE (1800-154)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:ANNE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:1800-154
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 ALDERSON ST
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-3614
Mailing Address - Country:US
Mailing Address - Phone:715-359-4257
Mailing Address - Fax:
Practice Address - Street 1:6001 ALDERSON ST
Practice Address - Street 2:
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-3614
Practice Address - Country:US
Practice Address - Phone:715-359-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1800-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist