Provider Demographics
NPI:1912283284
Name:DINICOLANTONIO, TRACEY PAULIN (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:PAULIN
Last Name:DINICOLANTONIO
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:MISS
Other - First Name:TRACEY
Other - Middle Name:EILEEN
Other - Last Name:PAULIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1500 COLVIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1118
Mailing Address - Country:US
Mailing Address - Phone:716-874-8400
Mailing Address - Fax:
Practice Address - Street 1:1500 COLVIN BLVD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-1118
Practice Address - Country:US
Practice Address - Phone:716-874-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006769-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist