Provider Demographics
NPI:1114131299
Name:BAZEGIAN, TRACY E (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:TRACY
Middle Name:E
Last Name:BAZEGIAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MAIN ST
Mailing Address - Street 2:UNIT 12D
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-1840
Mailing Address - Country:US
Mailing Address - Phone:978-562-5085
Mailing Address - Fax:
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:HOQ-GROUND FLOOR, REHAB SERVICES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-562-7735
Practice Address - Fax:617-562-7115
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4841235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist