Provider Demographics
NPI:1306166608
Name:VANCUYCK, TRACY SUSAN (BA, SPEECH PATHOLOGY)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:SUSAN
Last Name:VANCUYCK
Suffix:
Gender:F
Credentials:BA, SPEECH PATHOLOGY
Other - Prefix:MISS
Other - First Name:TRACY
Other - Middle Name:SUSAN
Other - Last Name:DE GRANDMAISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4189 E SEASONS CIR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-6612
Mailing Address - Country:US
Mailing Address - Phone:480-272-7256
Mailing Address - Fax:
Practice Address - Street 1:4189 E SEASONS CIR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-6612
Practice Address - Country:US
Practice Address - Phone:480-272-7256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist