Provider Demographics
NPI:1356378822
Name:DUCEY, TRACY DAWN (MS,CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:DAWN
Last Name:DUCEY
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 1:312 VENUS DR
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-2323
Mailing Address - Country:US
Mailing Address - Phone:618-580-9071
Mailing Address - Fax:618-467-1809
Practice Address - Street 1:312 VENUS DR
Practice Address - Street 2:
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-2323
Practice Address - Country:US
Practice Address - Phone:618-580-9071
Practice Address - Fax:618-467-1809
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist