Provider Demographics
NPI:1588806376
Name:WHITNEY, TRACY LOUISE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LOUISE
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 TEAKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:KY
Mailing Address - Zip Code:41048-7002
Mailing Address - Country:US
Mailing Address - Phone:859-534-5811
Mailing Address - Fax:
Practice Address - Street 1:1704 TEAKWOOD LN
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:KY
Practice Address - Zip Code:41048-7002
Practice Address - Country:US
Practice Address - Phone:859-534-5811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3376235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist