Provider Demographics
NPI:1326786039
Name:WONG, TRACY MAY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:MAY
Last Name:WONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 E ALDER ST APT 301
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-7420
Mailing Address - Country:US
Mailing Address - Phone:678-900-6571
Mailing Address - Fax:
Practice Address - Street 1:1700 EDMONDS AVE NE STE B
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-2713
Practice Address - Country:US
Practice Address - Phone:425-747-4004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty