Provider Demographics
NPI:1811221021
Name:BURGER, TRACY M (MS, MS)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:M
Last Name:BURGER
Suffix:
Gender:F
Credentials:MS, MS
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:M
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2603
Mailing Address - Street 2:HTN, CLIENT ACCOUNTING
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76113-2603
Mailing Address - Country:US
Mailing Address - Phone:817-569-4300
Mailing Address - Fax:817-569-4517
Practice Address - Street 1:3840 HULEN ST
Practice Address - Street 2:HTN
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7277
Practice Address - Country:US
Practice Address - Phone:817-569-4300
Practice Address - Fax:817-569-4517
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51510231H00000X
TX19092235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82S528OtherBLUE CROSS BLUE SHIELD
TX210765805Medicaid