Provider Demographics
NPI:1275683914
Name:DIAS, CLO TRACY (MA CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:CLO
Middle Name:TRACY
Last Name:DIAS
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:CLO
Other - Middle Name:
Other - Last Name:DIAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5214 S EAST STREET
Mailing Address - Street 2:BUILDING D SUITE 1
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227
Mailing Address - Country:US
Mailing Address - Phone:800-486-4449
Mailing Address - Fax:317-780-3750
Practice Address - Street 1:5214 S EAST STREET
Practice Address - Street 2:BUILDING D SUITE 1 HTS OUTPATIENT THERAPY SERVICES
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227
Practice Address - Country:US
Practice Address - Phone:800-486-4449
Practice Address - Fax:317-780-3750
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INZZ00Z501A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist