Provider Demographics
NPI:1093169435
Name:LEWIS, TRACY LEE
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:OSBORNE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6000 YOUNGSTOWN-NILES RD.
Mailing Address - Street 2:TRUMBULL COUNTY EDUCATIONAL SERVICE CENTER
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446
Mailing Address - Country:US
Mailing Address - Phone:330-505-2800
Mailing Address - Fax:330-505-2814
Practice Address - Street 1:905 MILTON BLVD.
Practice Address - Street 2:NEWTON FALLS SCHOOLS
Practice Address - City:NEWTON FALLS
Practice Address - State:OH
Practice Address - Zip Code:44444
Practice Address - Country:US
Practice Address - Phone:330-872-0695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-4357235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist