Provider Demographics
NPI:1811478134
Name:SHIPPY, TRACIE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:SHIPPY
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 1:421 E ROYAL LN STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3102
Mailing Address - Country:US
Mailing Address - Phone:469-400-1227
Mailing Address - Fax:
Practice Address - Street 1:421 E ROYAL LN STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3102
Practice Address - Country:US
Practice Address - Phone:469-400-1227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113495235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113495OtherTDLR
TX14172746OtherASHA
TX472804001Medicaid