Provider Demographics
NPI:1194986406
Name:TRACY BARBER SPEECH THERAPY SERVICES, PLLC
Entity type:Organization
Organization Name:TRACY BARBER SPEECH THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:CCC
Authorized Official - Phone:336-687-0808
Mailing Address - Street 1:PO BOX 4504
Mailing Address - Street 2:
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-4504
Mailing Address - Country:US
Mailing Address - Phone:336-687-0808
Mailing Address - Fax:336-307-4001
Practice Address - Street 1:1015 BRADFORD LN
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-3099
Practice Address - Country:US
Practice Address - Phone:336-687-0808
Practice Address - Fax:336-307-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4592305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service