Provider Demographics
NPI:1346934189
Name:KAMMERER, TRACY ELIZABETH
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ELIZABETH
Last Name:KAMMERER
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 1:2998 OLD TAYLOR RD APT 1723
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5657
Mailing Address - Country:US
Mailing Address - Phone:720-261-5537
Mailing Address - Fax:
Practice Address - Street 1:5740 GETWELL ROAD
Practice Address - Street 2:BUILDING 9 SUITE A
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672
Practice Address - Country:US
Practice Address - Phone:901-302-8101
Practice Address - Fax:833-645-9305
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist