Provider Demographics
NPI:1407845647
Name:LEEDOM, TRACEY PAULSON (MS)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:PAULSON
Last Name:LEEDOM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 FOREST GROVE CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-9104
Mailing Address - Country:US
Mailing Address - Phone:919-596-1931
Mailing Address - Fax:
Practice Address - Street 1:DUKE SOUTH CLINIC BUILDING 3828A RED ZONE
Practice Address - Street 2:BOX 2974
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-684-3181
Practice Address - Fax:919-668-6119
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS