Provider Demographics
NPI:1023754785
Name:DAGATA LOVEJOY, TRACI JO (MA, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:JO
Last Name:DAGATA LOVEJOY
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:PO BOX 18246
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-0246
Mailing Address - Country:US
Mailing Address - Phone:727-458-8944
Mailing Address - Fax:
Practice Address - Street 1:3033 SAINT LUKES LN
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-4475
Practice Address - Country:US
Practice Address - Phone:410-887-1304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist