Provider Demographics
NPI:1881726115
Name:LENZY, TRACIE N
Entity type:Individual
Prefix:MS
First Name:TRACIE
Middle Name:N
Last Name:LENZY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 HOLMES RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-2802
Mailing Address - Country:US
Mailing Address - Phone:816-349-3300
Mailing Address - Fax:
Practice Address - Street 1:8701 HOLMES RD
Practice Address - Street 2:CENTER 58
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-2802
Practice Address - Country:US
Practice Address - Phone:816-349-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO468073309Medicaid