Provider Demographics
NPI:1134426307
Name:PERRIN, TRACY (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:PERRIN
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:GARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4165 ALABAMA AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5603
Mailing Address - Country:US
Mailing Address - Phone:202-582-5656
Mailing Address - Fax:
Practice Address - Street 1:4165 ALABAMA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5603
Practice Address - Country:US
Practice Address - Phone:202-582-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD005599235Z00000X
DCSLP000462235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist