Provider Demographics
NPI:1366673576
Name:FRANK, TRACINDA (TRACI) (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:TRACINDA (TRACI)
Middle Name:
Last Name:FRANK
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP-CCC
Mailing Address - Street 1:56 MIZPAH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-2929
Mailing Address - Country:US
Mailing Address - Phone:415-586-2341
Mailing Address - Fax:415-586-2341
Practice Address - Street 1:56 MIZPAH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-2929
Practice Address - Country:US
Practice Address - Phone:415-586-2341
Practice Address - Fax:415-586-2341
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15786235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist