Provider Demographics
NPI:1215554738
Name:PEARL, TRACEY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:PEARL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 SIGNAL RIDGE DR STE 140
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3788
Mailing Address - Country:US
Mailing Address - Phone:405-674-6304
Mailing Address - Fax:405-281-0881
Practice Address - Street 1:1701 SIGNAL RIDGE DR STE 140
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3788
Practice Address - Country:US
Practice Address - Phone:405-674-6304
Practice Address - Fax:405-281-0881
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist