Provider Demographics
NPI:1932313285
Name:APPLE, TRACY BELLE (MA,SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:BELLE
Last Name:APPLE
Suffix:
Gender:F
Credentials:MA,SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1665
Mailing Address - Country:US
Mailing Address - Phone:856-596-6019
Mailing Address - Fax:
Practice Address - Street 1:3718 CHURCH RD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1104
Practice Address - Country:US
Practice Address - Phone:856-235-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYS 03013235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJYS 03013OtherNJ STATE LICENSE
09130979OtherASHA CERTIFICATION
PASL004821LOtherPA STATE LICENSE