Provider Demographics
NPI:1346478674
Name:THOMAS, TRACEY LANE (SLP)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LANE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 LAKE MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-7434
Mailing Address - Country:US
Mailing Address - Phone:412-580-8300
Mailing Address - Fax:
Practice Address - Street 1:300 NORTHPOINTE CIR
Practice Address - Street 2:STE 102
Practice Address - City:SEVEN FIELDS
Practice Address - State:PA
Practice Address - Zip Code:16046-7862
Practice Address - Country:US
Practice Address - Phone:412-580-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004307L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist