Provider Demographics
NPI:1326112509
Name:VAIL, TRACY LYNN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:VAIL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:ALDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:106 CHERRY HILL LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-9711
Mailing Address - Country:US
Mailing Address - Phone:919-854-2902
Mailing Address - Fax:
Practice Address - Street 1:1611 JONES FRANKLIN RD
Practice Address - Street 2:SUITE 109
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-3376
Practice Address - Country:US
Practice Address - Phone:919-852-0702
Practice Address - Fax:919-852-0742
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2190235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7484728Medicaid