Provider Demographics
NPI:1205161049
Name:SODER, TRACIE LARA (MA)
Entity type:Individual
Prefix:MS
First Name:TRACIE
Middle Name:LARA
Last Name:SODER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19040 COX AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-6601
Mailing Address - Country:US
Mailing Address - Phone:408-996-2357
Mailing Address - Fax:
Practice Address - Street 1:19040 COX AVE STE 5
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-6601
Practice Address - Country:US
Practice Address - Phone:408-996-2357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP13253235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist