Provider Demographics
NPI:1912102211
Name:REED, TRACY ANN (SLP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:REED
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:ANN
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:6421 S KINGSHIGHWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-3742
Mailing Address - Country:US
Mailing Address - Phone:314-351-1330
Mailing Address - Fax:
Practice Address - Street 1:6421 S KINGSHIGHWAY BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-3742
Practice Address - Country:US
Practice Address - Phone:314-351-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118150235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist