Provider Demographics
NPI:1255720199
Name:WINOT, TRACY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:WINOT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 GROVEVILLE RD
Mailing Address - Street 2:APT. H1E
Mailing Address - City:BUXTON
Mailing Address - State:ME
Mailing Address - Zip Code:04093-3501
Mailing Address - Country:US
Mailing Address - Phone:802-535-2471
Mailing Address - Fax:
Practice Address - Street 1:32 TANDBERG TRL
Practice Address - Street 2:SUITE 7
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-6417
Practice Address - Country:US
Practice Address - Phone:207-893-1599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP2250235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist