Provider Demographics
NPI:1346673993
Name:METZGER, TRACEY LEIGH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:TRACEY
Middle Name:LEIGH
Last Name:METZGER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72112-3933
Mailing Address - Country:US
Mailing Address - Phone:870-217-2193
Mailing Address - Fax:
Practice Address - Street 1:955 WATER ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-3455
Practice Address - Country:US
Practice Address - Phone:870-793-6831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#3368235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist