Provider Demographics
NPI:1134692866
Name:MCKAY, TRACY LYNN (SLP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:MCKAY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2757 SPINNERBAIT CT
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-2442
Mailing Address - Country:US
Mailing Address - Phone:904-501-5856
Mailing Address - Fax:
Practice Address - Street 1:3495 HOFFMAN ST
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-4770
Practice Address - Country:US
Practice Address - Phone:904-400-7016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8675235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist