Provider Demographics
NPI:1285750687
Name:PARKER, TRACY MITCHELL (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:MITCHELL
Last Name:PARKER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1596 WALL DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-3238
Mailing Address - Country:US
Mailing Address - Phone:443-618-9217
Mailing Address - Fax:
Practice Address - Street 1:1527 STAR STELLA DR
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-3705
Practice Address - Country:US
Practice Address - Phone:410-674-8439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2855235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist