Provider Demographics
NPI:1386929107
Name:FARNHAM-KUCERA, TRACY (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:FARNHAM-KUCERA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:MCCLENAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:141 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1505
Mailing Address - Country:US
Mailing Address - Phone:607-743-4448
Mailing Address - Fax:
Practice Address - Street 1:666 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1313
Practice Address - Country:US
Practice Address - Phone:607-930-1015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088531235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist