Provider Demographics
NPI:1184901142
Name:O'LEARY, TRACY-ANN (SLP)
Entity type:Individual
Prefix:MRS
First Name:TRACY-ANN
Middle Name:
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:TRACY-ANN
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:57 ASHLAND DR
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-4018
Mailing Address - Country:US
Mailing Address - Phone:631-656-9617
Mailing Address - Fax:
Practice Address - Street 1:2850 N JERUSALEM RD
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-1125
Practice Address - Country:US
Practice Address - Phone:516-396-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011933-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist