Provider Demographics
NPI:1922157700
Name:WESTON, TRACIE L (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:L
Last Name:WESTON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W HORNBEAM DR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2532
Mailing Address - Country:US
Mailing Address - Phone:407-682-5137
Mailing Address - Fax:407-682-5952
Practice Address - Street 1:315 W HORNBEAM DR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-2532
Practice Address - Country:US
Practice Address - Phone:407-682-5137
Practice Address - Fax:407-682-5952
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA0002643235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist