Provider Demographics
NPI:1659889434
Name:KILCOYNE, TRACEY LYNN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNN
Last Name:KILCOYNE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1818 POT SPRING RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4450
Mailing Address - Country:US
Mailing Address - Phone:410-583-5765
Mailing Address - Fax:
Practice Address - Street 1:1818 POT SPRING RD STE 100
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4450
Practice Address - Country:US
Practice Address - Phone:410-583-5765
Practice Address - Fax:410-583-5765
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07063235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist