Provider Demographics
NPI:1083215768
Name:BECKMANN, TRACIE LEE
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:LEE
Last Name:BECKMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 FALCON HILL TRL
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8194
Mailing Address - Country:US
Mailing Address - Phone:636-448-0995
Mailing Address - Fax:
Practice Address - Street 1:731 FALCON HILL TRL
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8194
Practice Address - Country:US
Practice Address - Phone:636-448-0995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV26793235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist