Provider Demographics
NPI:1942530993
Name:CONNER, TRACY (MA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:CONNER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 SIGMA RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-4422
Mailing Address - Country:US
Mailing Address - Phone:972-756-0500
Mailing Address - Fax:972-756-0448
Practice Address - Street 1:4300 SIGMA RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4422
Practice Address - Country:US
Practice Address - Phone:972-756-0500
Practice Address - Fax:972-756-0448
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114350235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist