Provider Demographics
NPI:1902894900
Name:MURPHY, TRACY L (AUD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:L
Last Name:MURPHY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 PARK AVE W
Mailing Address - Street 2:4 SOUTH
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2230
Mailing Address - Country:US
Mailing Address - Phone:847-432-5555
Mailing Address - Fax:847-432-5554
Practice Address - Street 1:1160 PARK AVE W
Practice Address - Street 2:4 SOUTH
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2271
Practice Address - Country:US
Practice Address - Phone:847-432-5555
Practice Address - Fax:847-432-5554
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000702231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL61300Medicare ID - Type Unspecified