Provider Demographics
NPI:1144486606
Name:MYERS, TRACY DAWN (MSP,CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:DAWN
Last Name:MYERS
Suffix:
Gender:F
Credentials:MSP,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-1712
Mailing Address - Country:US
Mailing Address - Phone:870-763-3776
Mailing Address - Fax:
Practice Address - Street 1:1214 N 6TH ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-1712
Practice Address - Country:US
Practice Address - Phone:870-763-3776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR384235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist