Provider Demographics
NPI:1457031221
Name:REID, TRACI LYNN (SLPA)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LYNN
Last Name:REID
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1261
Mailing Address - Street 2:
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-1261
Mailing Address - Country:US
Mailing Address - Phone:928-280-8700
Mailing Address - Fax:
Practice Address - Street 1:46 DESERT DRIVE
Practice Address - Street 2:
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045-1261
Practice Address - Country:US
Practice Address - Phone:928-280-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA126282355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant