Provider Demographics
NPI:1720218936
Name:MARCHETTI, TRACY ELLEN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ELLEN
Last Name:MARCHETTI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11335 MUSETTE CIR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2127
Mailing Address - Country:US
Mailing Address - Phone:404-402-0740
Mailing Address - Fax:
Practice Address - Street 1:11335 MUSETTE CIR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2127
Practice Address - Country:US
Practice Address - Phone:404-402-0740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA005478235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist