Provider Demographics
NPI:1194959635
Name:JONES, TRACY SHELL (MCD, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:SHELL
Last Name:JONES
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5118 PARK AVE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-5720
Mailing Address - Country:US
Mailing Address - Phone:901-683-8787
Mailing Address - Fax:901-683-8717
Practice Address - Street 1:5118 PARK AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-5720
Practice Address - Country:US
Practice Address - Phone:901-683-8787
Practice Address - Fax:901-683-8717
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3114235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist