MEDICARE: MR. TRACY BRANDON BALL CCC -SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	12106381	NC

General Provider Information

NPI Number	:	1306144423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TRACY BRANDON BALL CCC -SLP

Provider Business Mailing Address
First Line	:	509 DONATELLO AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-4555
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 DONATELLO AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-4555
Country	:	US
Telephone Number	:	828-773-4483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2011
Last Update Date	:	03/14/2011

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Directions to “ MR. TRACY BRANDON BALL CCC -SLP” Practice Location

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