Provider Demographics
NPI:1528215357
Name:JEANE, TRACY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:JEANE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WESTERN HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-9542
Mailing Address - Country:US
Mailing Address - Phone:501-336-8243
Mailing Address - Fax:
Practice Address - Street 1:8 WESTERN HILLS CIR
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9542
Practice Address - Country:US
Practice Address - Phone:501-336-8243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSLP#1383235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist