Provider Demographics
NPI:1750825055
Name:BARRETT, TRACY (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:BARRETT
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 1:3044 E MINNESOTA ST APT 106
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57703-6138
Mailing Address - Country:US
Mailing Address - Phone:605-431-4967
Mailing Address - Fax:
Practice Address - Street 1:3044 E MINNESOTA ST APT 106
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57703-6138
Practice Address - Country:US
Practice Address - Phone:605-431-4967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD466235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist