Healthcare Provider Details

I. General information

NPI: 1780849927
Provider Name (Legal Business Name): TRACY WREN PERKEY MCD,CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY DAWN WREN MCD,CCC-SLP

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 PINE GROVE LN
HARRISBURG AR
72432-9304
US

IV. Provider business mailing address

2804 CARRIAGE HILL DR
PARAGOULD AR
72450-8361
US

V. Phone/Fax

Practice location:
  • Phone: 870-578-5426
  • Fax: 870-578-6005
Mailing address:
  • Phone: 870-897-0208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: