MEDICARE: MRS. TRACY BELLE APPLE M.A.,SLP-CCC

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	YS 03013	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	YS 03013	OTHER	NJ	NJ STATE LICENSE
2	09130979	OTHER		ASHA CERTIFICATION
3	SL004821L	OTHER	PA	PA STATE LICENSE

General Provider Information

NPI Number	:	1932313285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACY BELLE APPLE M.A.,SLP-CCC

Provider Business Mailing Address
First Line	:	118 WESTMINSTER AVE
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-1665
Country	:	US
Telephone Number	:	856-596-6019
Fax Number	:

Provider Business Practice Location Address
First Line	:	3718 CHURCH RD
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-1104
Country	:	US
Telephone Number	:	856-235-7100
Fax Number	:

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/08/2007

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Directions to “ MRS. TRACY BELLE APPLE M.A.,SLP-CCC” Practice Location

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