Provider Demographics
NPI:1235239781
Name:BAJADEK, TRACY LYN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYN
Last Name:BAJADEK
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 1:203 PINE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:NEWFOUNDLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18445-2143
Mailing Address - Country:US
Mailing Address - Phone:570-676-4483
Mailing Address - Fax:
Practice Address - Street 1:1219 N 5TH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2646
Practice Address - Country:US
Practice Address - Phone:570-421-2232
Practice Address - Fax:570-421-1825
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007601235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008740560001Medicaid