Provider Demographics
NPI:1043562846
Name:TRACER, GALE ELIZABETH (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:GALE
Middle Name:ELIZABETH
Last Name:TRACER
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:GALE
Other - Middle Name:ELIZABETH
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2046
Practice Address - Street 1:31741 RANCHO VIEJO RD
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-6722
Practice Address - Country:US
Practice Address - Phone:949-248-8855
Practice Address - Fax:949-667-0205
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3262235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist