Provider Demographics
NPI:1235421512
Name:AHLERT, TRACY ROXANNE (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:ROXANNE
Last Name:AHLERT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 W CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-3905
Mailing Address - Country:US
Mailing Address - Phone:479-632-0258
Mailing Address - Fax:
Practice Address - Street 1:14 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-3905
Practice Address - Country:US
Practice Address - Phone:479-632-0258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1389235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR186282721Medicaid