MEDICARE: TRACY BARRETT SPEECH PATHOLOGIST

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	466	SD

General Provider Information

NPI Number	:	1750825055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY BARRETT SPEECH PATHOLOGIST

Provider Business Mailing Address
First Line	:	3044 E MINNESOTA ST APT 106
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57703-6138
Country	:	US
Telephone Number	:	605-431-4967
Fax Number	:

Provider Business Practice Location Address
First Line	:	3044 E MINNESOTA ST APT 106
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57703-6138
Country	:	US
Telephone Number	:	605-431-4967
Fax Number	:

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

Provider Enumeration Date	:	12/06/2016
Last Update Date	:	12/06/2016

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Directions to “ TRACY BARRETT SPEECH PATHOLOGIST” Practice Location

Language	Start Address	Practice Location

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