Provider Demographics
NPI:1619359098
Name:HOOVER, TRACY (AUD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:HOOVER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:WEISBROD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:11311 APPLEJACK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-4714
Mailing Address - Country:US
Mailing Address - Phone:847-708-4221
Mailing Address - Fax:
Practice Address - Street 1:1100 WILFORD HALL LOOP BLDG 4554
Practice Address - Street 2:
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236
Practice Address - Country:US
Practice Address - Phone:210-229-6225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD60573251231H00000X
OHA.02063231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2047357Medicaid
WAG8942395Medicare PIN