Provider Demographics
NPI:1205167368
Name:TRACY, MEGAN DEE (MSCCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:DEE
Last Name:TRACY
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:DEE
Other - Last Name:LAFFERTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1003 N LUSK AVE
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-2407
Mailing Address - Country:US
Mailing Address - Phone:405-626-8701
Mailing Address - Fax:
Practice Address - Street 1:1003 N LUSK AVE
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-2407
Practice Address - Country:US
Practice Address - Phone:405-626-8701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3518235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist