Provider Demographics
NPI:1891038451
Name:LEVAY, TRACI
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:LEVAY
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 1:9820 SW ARDENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-4913
Mailing Address - Country:US
Mailing Address - Phone:503-860-3580
Mailing Address - Fax:
Practice Address - Street 1:9820 SW ARDENWOOD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-4913
Practice Address - Country:US
Practice Address - Phone:503-860-3580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12702235Z00000X
WALL 00004341235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist