Provider Demographics
NPI:1346459708
Name:STRETCH, TRACEY LUE (BC-HIS)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:LUE
Last Name:STRETCH
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 HIGHWAY 36 W
Mailing Address - Street 2:#410
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4034
Mailing Address - Country:US
Mailing Address - Phone:651-746-0400
Mailing Address - Fax:651-746-0404
Practice Address - Street 1:1700 HIGHWAY 36 W
Practice Address - Street 2:#410
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4034
Practice Address - Country:US
Practice Address - Phone:651-746-0400
Practice Address - Fax:651-746-0404
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2056237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN97D84BEOtherBCBS PROVIDER NUMBER