Provider Demographics
NPI:1336311588
Name:SWANSON, TRACY (AUD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3300
Mailing Address - Fax:704-295-3468
Practice Address - Street 1:6035 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3256
Practice Address - Country:US
Practice Address - Phone:704-295-3300
Practice Address - Fax:704-295-3468
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3562231H00000X
NC825237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
4545571OtherAENTA
5334830OtherCIGNA
7722213OtherWELLCARE
SCSAN095Medicaid
NC163X7OtherBCBSNC
SC30111572OtherSELECT HEALTH OF SC
NC7413294Medicaid
NCP01044542OtherRAILROAD MEDICARE PTAN
NC2699628Medicare PIN