Provider Demographics
NPI:1285930669
Name:TRACY GEIST THERAPY SERVICES
Entity type:Organization
Organization Name:TRACY GEIST THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:DIANA
Authorized Official - Last Name:GEIST
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP/L
Authorized Official - Phone:610-393-7980
Mailing Address - Street 1:945 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071-6569
Mailing Address - Country:US
Mailing Address - Phone:610-393-7980
Mailing Address - Fax:610-377-9125
Practice Address - Street 1:945 WALNUT DR
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-6569
Practice Address - Country:US
Practice Address - Phone:610-393-7980
Practice Address - Fax:610-377-9125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004744L252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024266460001Medicaid
PA1024266460002Medicaid