Provider Demographics
NPI:1659512606
Name:HOWELL, TRACIE LEE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:LEE
Last Name:HOWELL
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 1:441 LANCASTER FARM RD
Mailing Address - Street 2:
Mailing Address - City:ROEBUCK
Mailing Address - State:SC
Mailing Address - Zip Code:29376-3727
Mailing Address - Country:US
Mailing Address - Phone:864-205-1410
Mailing Address - Fax:
Practice Address - Street 1:441 LANCASTER FARM RD
Practice Address - Street 2:
Practice Address - City:ROEBUCK
Practice Address - State:SC
Practice Address - Zip Code:29376-3727
Practice Address - Country:US
Practice Address - Phone:864-205-1410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2707235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist