Provider Demographics
NPI:1629208962
Name:SHORTRIDGE, TRACI M (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:M
Last Name:SHORTRIDGE
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 1:15701 E 1ST AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9038
Mailing Address - Country:US
Mailing Address - Phone:303-326-1485
Mailing Address - Fax:
Practice Address - Street 1:15701 E 1ST AVE STE 206
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-9038
Practice Address - Country:US
Practice Address - Phone:303-326-1485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist