Healthcare Provider Details

I. General information

NPI: 1508491523
Provider Name (Legal Business Name): PAULA TRACY SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 MAIN ST STE 311
PLYMOUTH NH
03264-1500
US

IV. Provider business mailing address

PO BOX 307
PLYMOUTH NH
03264-0307
US

V. Phone/Fax

Practice location:
  • Phone: 603-481-0055
  • Fax:
Mailing address:
  • Phone: 603-481-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number0200
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: