Provider Demographics
NPI:1669646139
Name:ROBISON, TRACY (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:ROBISON
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22290 COUNTY ROAD 267
Mailing Address - Street 2:
Mailing Address - City:PUXICO
Mailing Address - State:MO
Mailing Address - Zip Code:63960-7379
Mailing Address - Country:US
Mailing Address - Phone:573-568-2253
Mailing Address - Fax:573-222-2375
Practice Address - Street 1:22290 COUNTY ROAD 267
Practice Address - Street 2:
Practice Address - City:PUXICO
Practice Address - State:MO
Practice Address - Zip Code:63960-7379
Practice Address - Country:US
Practice Address - Phone:573-568-2253
Practice Address - Fax:573-222-2375
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000162975235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist