Provider Demographics
NPI:1912958406
Name:STONE, TRACI LYNN (MSE, ATC, LAT, CSCS)
Entity type:Individual
Prefix:MISS
First Name:TRACI
Middle Name:LYNN
Last Name:STONE
Suffix:
Gender:F
Credentials:MSE, ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 S CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-3551
Mailing Address - Country:US
Mailing Address - Phone:712-251-4415
Mailing Address - Fax:
Practice Address - Street 1:3303 REBECCA ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104
Practice Address - Country:US
Practice Address - Phone:180-066-2330
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA005592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer