Provider Demographics
NPI:1134467681
Name:SCHLICKSUP, TRACY KOON (DVM)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:KOON
Last Name:SCHLICKSUP
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 SALTERBECK CT
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7118
Mailing Address - Country:US
Mailing Address - Phone:843-971-7774
Mailing Address - Fax:
Practice Address - Street 1:3400 SALTERBECK CT
Practice Address - Street 2:SUITE 104
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7118
Practice Address - Country:US
Practice Address - Phone:843-971-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3146174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian