Provider Demographics
NPI:1013441708
Name:DANIEL, TRACIE CAROLE (SLP)
Entity type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:CAROLE
Last Name:DANIEL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 JACQUELYN LN
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-7723
Mailing Address - Country:US
Mailing Address - Phone:918-335-3005
Mailing Address - Fax:
Practice Address - Street 1:5121 JACQUELYN LN
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-7723
Practice Address - Country:US
Practice Address - Phone:918-335-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2132235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist