Provider Demographics
NPI:1598428252
Name:SCHLISKE, TRACY (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:SCHLISKE
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:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201-0032
Mailing Address - Country:US
Mailing Address - Phone:307-331-8354
Mailing Address - Fax:
Practice Address - Street 1:555 S WYOMING
Practice Address - Street 2:
Practice Address - City:GUERNSEY
Practice Address - State:WY
Practice Address - Zip Code:82214-5211
Practice Address - Country:US
Practice Address - Phone:307-836-2733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-799235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist