Provider Demographics
NPI:1386389047
Name:TRACY, KATHERINE E (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:TRACY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:E
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:34607 F50 RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORD
Mailing Address - State:CO
Mailing Address - Zip Code:81415-8911
Mailing Address - Country:US
Mailing Address - Phone:419-707-2348
Mailing Address - Fax:
Practice Address - Street 1:34607 F50 RD
Practice Address - Street 2:
Practice Address - City:CRAWFORD
Practice Address - State:CO
Practice Address - Zip Code:81415-8911
Practice Address - Country:US
Practice Address - Phone:419-707-2348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0004079235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist