Provider Demographics
NPI:1851778500
Name:TRACY, HALEY GATLIN
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:GATLIN
Last Name:TRACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4003 EMERALD SPRING PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-2804
Mailing Address - Country:US
Mailing Address - Phone:270-875-2333
Mailing Address - Fax:
Practice Address - Street 1:4003 EMERALD SPRING PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-2804
Practice Address - Country:US
Practice Address - Phone:270-875-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46002734A235Z00000X
KY167104235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist