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General NPI Number Information
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NPI Number | 1952874125
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Entity Type | Individual
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Provider Name | TRACY ANN SHIELDS MA,CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 01/09/2019
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Last Update Date | 01/09/2019
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Provider Practice Location Address
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Address Line | 4005 RIPA AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63125-2378
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Country | US
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Telephone | 314-544-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 558 S HARRISON AVE
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City | KIRKWOOD
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State | MO
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Zip | 63122-5909
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Country | US
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Telephone | 314-276-0071
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 111684
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License Number State | MO
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