Provider Demographics
NPI:1407285570
Name:HUDSON, TRACEY ELIZABETH (AUD CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:ELIZABETH
Last Name:HUDSON
Suffix:
Gender:F
Credentials:AUD CCC-A
Other - Prefix:MISS
Other - First Name:TRACEY
Other - Middle Name:ELIZABETH
Other - Last Name:HERRIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:860 OMNI BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:
Practice Address - Street 1:860 OMNI BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4434
Practice Address - Country:US
Practice Address - Phone:757-534-7975
Practice Address - Fax:757-534-7902
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA22010015-39237600000X
VA2201001539231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA640000098Medicare UPIN