Healthcare Provider Details

I. General information

NPI: 1255487427
Provider Name (Legal Business Name): TRACY D HUKILL MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 AMANDA CT
LEXINGTON KY
40515-6267
US

IV. Provider business mailing address

909 AMANDA CT
LEXINGTON KY
40515-6267
US

V. Phone/Fax

Practice location:
  • Phone: 859-971-8135
  • Fax: 859-971-7152
Mailing address:
  • Phone: 859-971-8135
  • Fax: 859-971-7152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberKY-2506
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: