Provider Demographics
NPI:1588381677
Name:HACK, TRICIA LYNNE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:LYNNE
Last Name:HACK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10354 BERMUDA DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4635
Mailing Address - Country:US
Mailing Address - Phone:954-465-4858
Mailing Address - Fax:
Practice Address - Street 1:10354 BERMUDA DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33026-4635
Practice Address - Country:US
Practice Address - Phone:954-465-4858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4694235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist