MEDICARE: MRS. TRACI L HIPWELL M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2417-154	WI

General Provider Information

NPI Number	:	1235196726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACI L HIPWELL M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	14 ELLIS POTTER CT
Second Line	:	SUITE 200
City	:	MADISON
State	:	WI
Zip	:	53711-2478
Country	:	US
Telephone Number	:	608-204-6242
Fax Number	:	608-204-6249

Provider Business Practice Location Address
First Line	:	14 ELLIS POTTER CT
Second Line	:	SUITE 200
City	:	MADISON
State	:	WI
Zip	:	53711-2478
Country	:	US
Telephone Number	:	608-204-6242
Fax Number	:	608-204-6249

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	05/02/2008

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Directions to “ MRS. TRACI L HIPWELL M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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