Provider Demographics
NPI:1770258337
Name:VALLETTA, TRACI MARIE (SLP)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:MARIE
Last Name:VALLETTA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 SW VIZCAYA CIR
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-1964
Mailing Address - Country:US
Mailing Address - Phone:772-215-7275
Mailing Address - Fax:
Practice Address - Street 1:1405 SW VIZCAYA CIR
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-1964
Practice Address - Country:US
Practice Address - Phone:772-215-7275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-14
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist