Provider Demographics
NPI:1841590866
Name:MANSFIELD, TRACY CAMERON (PHD, CCC-SLP, ATP)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:CAMERON
Last Name:MANSFIELD
Suffix:
Gender:M
Credentials:PHD, CCC-SLP, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 KINGS NORTH ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8507
Mailing Address - Country:US
Mailing Address - Phone:541-221-4774
Mailing Address - Fax:
Practice Address - Street 1:1755 KINGS NORTH ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8507
Practice Address - Country:US
Practice Address - Phone:541-221-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2015-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225CA2400X
OR12851235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner