Provider Demographics
NPI:1841316361
Name:VIRTA, TRACY CHAPIN (MA CCC A)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:CHAPIN
Last Name:VIRTA
Suffix:
Gender:F
Credentials:MA CCC A
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:TICKNOR
Other - Last Name:VIRTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA CCC A
Mailing Address - Street 1:418 ISLAND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-6098
Mailing Address - Country:US
Mailing Address - Phone:616-738-7412
Mailing Address - Fax:
Practice Address - Street 1:1445 SHELDON RD
Practice Address - Street 2:HARBOR DUNES MEDICAL CENTER, SUITE 304
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2480
Practice Address - Country:US
Practice Address - Phone:616-935-6966
Practice Address - Fax:616-935-6967
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000328231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist