Provider Demographics
NPI:1285646885
Name:CHAMBERS, TRACY (MS)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:CHANBERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:2909 N FLAMINGO DR
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-2061
Mailing Address - Country:US
Mailing Address - Phone:505-393-0755
Mailing Address - Fax:505-393-0249
Practice Address - Street 1:2909 N FLAMINGO DR
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-2061
Practice Address - Country:US
Practice Address - Phone:505-393-0755
Practice Address - Fax:505-393-0249
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2427235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ4676Medicaid