Provider Demographics
NPI:1083808109
Name:CALLAHAN, TRACEY LEE (MS)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:LEE
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 OLD HARBOR ST # 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2924
Mailing Address - Country:US
Mailing Address - Phone:617-419-0424
Mailing Address - Fax:
Practice Address - Street 1:73 OLD HARBOR ST # 2
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-2924
Practice Address - Country:US
Practice Address - Phone:617-419-0424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist