Provider Demographics
NPI:1174640122
Name:LANHAM, TRACEY E (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:E
Last Name:LANHAM
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 E 6TH CIR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1502
Mailing Address - Country:US
Mailing Address - Phone:303-829-6753
Mailing Address - Fax:303-781-2779
Practice Address - Street 1:13547 W EXPOSITION DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-3041
Practice Address - Country:US
Practice Address - Phone:303-829-6753
Practice Address - Fax:303-781-2779
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO314231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist