Healthcare Provider Details

I. General information

NPI: 1528237963
Provider Name (Legal Business Name): TRACY WONG MS, CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 LOCUST ST
SAN FRANCISCO CA
94118-1844
US

IV. Provider business mailing address

423 LOCUST ST
SAN FRANCISCO CA
94118-1844
US

V. Phone/Fax

Practice location:
  • Phone: 415-922-6377
  • Fax:
Mailing address:
  • Phone: 415-922-6377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14584
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: