Provider Demographics
NPI:1629257753
Name:GOSS, TRACY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:GOSS
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 1:626 GRANT ST STE K
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4700
Mailing Address - Country:US
Mailing Address - Phone:703-904-8334
Mailing Address - Fax:
Practice Address - Street 1:626 GRANT ST STE K
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4700
Practice Address - Country:US
Practice Address - Phone:703-904-8334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002282235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist