Provider Demographics
NPI:1275733479
Name:BUFFUM, TRACEY ANNE (MED)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:ANNE
Last Name:BUFFUM
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GREENBRIAR PL
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02881-1733
Mailing Address - Country:US
Mailing Address - Phone:401-284-3680
Mailing Address - Fax:
Practice Address - Street 1:140 POINT JUDITH RD
Practice Address - Street 2:UNIT 44, J. TRUDEAU MEMORIAL CENTER
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-3451
Practice Address - Country:US
Practice Address - Phone:401-783-6853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00941235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist