Provider Demographics
NPI:1891739587
Name:DALY, TRACEY JANE (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:JANE
Last Name:DALY
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GOLF VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7302
Mailing Address - Country:US
Mailing Address - Phone:732-557-4881
Mailing Address - Fax:
Practice Address - Street 1:COMMUNITY MEDICAL CENTER - SPEECH PATHOLOGY DEPT.
Practice Address - Street 2:99 HIGHWAY 37 WEST
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755
Practice Address - Country:US
Practice Address - Phone:732-557-8000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00236800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist