Provider Demographics
NPI:1508277047
Name:DIAMOND, TRACEY L (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:L
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MANCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2256
Mailing Address - Country:US
Mailing Address - Phone:908-216-5269
Mailing Address - Fax:
Practice Address - Street 1:4 MANCHESTER DR
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2256
Practice Address - Country:US
Practice Address - Phone:908-216-5269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00555400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist