Healthcare Provider Details

I. General information

NPI: 1487599619
Provider Name (Legal Business Name): TRACY GWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1058 REDWOOD HWY FRONTAGE RD
MILL VALLEY CA
94941-1621
US

IV. Provider business mailing address

217 ARBALLO DR
SAN FRANCISCO CA
94132-2131
US

V. Phone/Fax

Practice location:
  • Phone: 415-924-2444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: