Provider Demographics
NPI:1043913718
Name:OUTMAN, TRACEY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:OUTMAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:
Other - Last Name:MARTIN-MASJUAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5551 W SHADY TRL
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-1319
Mailing Address - Country:US
Mailing Address - Phone:615-496-4914
Mailing Address - Fax:
Practice Address - Street 1:932 E BADDOUR PKWY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3700
Practice Address - Country:US
Practice Address - Phone:615-496-4914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1340235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist