Provider Demographics
NPI:1902070048
Name:ZIMMER, TRACY A
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:A
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:A
Other - Last Name:ZEGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:14 BROWER LN
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-6608
Mailing Address - Country:US
Mailing Address - Phone:610-505-5346
Mailing Address - Fax:
Practice Address - Street 1:14 BROWER LN
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-6608
Practice Address - Country:US
Practice Address - Phone:610-505-5346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004980L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019340760005Medicaid