Provider Demographics
NPI:1831329358
Name:TRUMBELL, TRACY TUYN (MA, CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:TUYN
Last Name:TRUMBELL
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W SURF ST APT 405
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6055
Mailing Address - Country:US
Mailing Address - Phone:773-573-7709
Mailing Address - Fax:773-598-8022
Practice Address - Street 1:550 W SURF ST APT 405
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6055
Practice Address - Country:US
Practice Address - Phone:773-573-7709
Practice Address - Fax:773-598-8022
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist