Provider Demographics
NPI:1033314828
Name:LYNCH, TRACEY LYN (AUD, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:LYN
Last Name:LYNCH
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SCHWAB RD STE 3
Mailing Address - Street 2:CLOCK TOWER PLAZA
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-1130
Mailing Address - Country:US
Mailing Address - Phone:631-271-1018
Mailing Address - Fax:631-271-1782
Practice Address - Street 1:1 SCHWAB RD STE 3
Practice Address - Street 2:CLOCK TOWER PLAZA
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-1130
Practice Address - Country:US
Practice Address - Phone:631-271-1018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2032231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist