Provider Demographics
NPI:1225545437
Name:STREET, TRACI PARNELL (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:PARNELL
Last Name:STREET
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 1:1039 HAVEN HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6051
Mailing Address - Country:US
Mailing Address - Phone:910-734-5075
Mailing Address - Fax:
Practice Address - Street 1:1039 HAVEN HOLLOW WAY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6051
Practice Address - Country:US
Practice Address - Phone:910-734-5075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist