Provider Demographics
NPI:1164703724
Name:HALE, TRACY (SLP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:HALE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:LANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 N EL PASO ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-2519
Mailing Address - Country:US
Mailing Address - Phone:719-520-2000
Mailing Address - Fax:
Practice Address - Street 1:1115 N EL PASO ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-2519
Practice Address - Country:US
Practice Address - Phone:719-520-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103253235Z00000X
CO24449092235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist