Provider Demographics
NPI:1962039891
Name:WALSH, TRACY LEE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEE
Last Name:WALSH
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:NOTTINGHAM SCHOOL
Mailing Address - Street 2:245 STAGE ROAD
Mailing Address - City:NOTTINGHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03290
Mailing Address - Country:US
Mailing Address - Phone:603-957-0093
Mailing Address - Fax:
Practice Address - Street 1:245 STAGE RD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:NH
Practice Address - Zip Code:03290-6206
Practice Address - Country:US
Practice Address - Phone:603-679-5632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0805235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist