Provider Demographics
NPI:1326398777
Name:LOOPER, TRACY NICHELLE (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:TRACY
Middle Name:NICHELLE
Last Name:LOOPER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5640 GLASS CHIMNEY LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-6091
Mailing Address - Country:US
Mailing Address - Phone:317-213-3135
Mailing Address - Fax:
Practice Address - Street 1:9165 OTIS AVE STE 101
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-2307
Practice Address - Country:US
Practice Address - Phone:317-213-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003184A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist