NPI | 1164703724 |
---|---|
Former Name | TRACY LANGE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CO 24449092) |
Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: TX 103253) |
Enumeration Date | 2011-09-08 |
Last Update Date | 2023-11-14 |