Provider Demographics
NPI:1033449707
Name:KRUGER, TRACEY (MS, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:
Last Name:KRUGER
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 1:28542 HIDDEN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91390-4293
Mailing Address - Country:US
Mailing Address - Phone:818-804-5258
Mailing Address - Fax:
Practice Address - Street 1:28542 HIDDEN HILLS DR
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91390-4293
Practice Address - Country:US
Practice Address - Phone:818-804-5258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-01
Last Update Date:2010-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2623231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist