Provider Demographics
NPI:1255748208
Name:LANGLOIS, TRACY (MS,CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:LANGLOIS
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WOODBURY HL
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-2959
Mailing Address - Country:US
Mailing Address - Phone:203-592-3627
Mailing Address - Fax:
Practice Address - Street 1:39 SHERMAN HILL RD STE C101
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3650
Practice Address - Country:US
Practice Address - Phone:860-329-7001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003905235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003905OtherSTATE OF CT