Provider Demographics
NPI:1164728457
Name:SIMMONS, TRACY ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:ANN
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7582 HIGHBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-1611
Mailing Address - Country:US
Mailing Address - Phone:315-682-4663
Mailing Address - Fax:
Practice Address - Street 1:8201 E SENECA TPKE
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-2103
Practice Address - Country:US
Practice Address - Phone:315-692-1203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7110941235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist