Provider Demographics
NPI:1629242268
Name:KAUFMANN, TRICIA RENEE (MS CCC-A)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:RENEE
Last Name:KAUFMANN
Suffix:
Gender:F
Credentials:MS CCC-A
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 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8077
Mailing Address - Country:US
Mailing Address - Phone:573-443-5913
Mailing Address - Fax:573-443-7395
Practice Address - Street 1:27 CONLEY RD
Practice Address - Street 2:SUITE 107
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6480
Practice Address - Country:US
Practice Address - Phone:573-443-5913
Practice Address - Fax:573-443-7395
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004026422231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO991826001Medicare PIN