Provider Demographics
NPI:1538148556
Name:ALTMANN, TRACY L (AUD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:ALTMANN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:L
Other - Last Name:OLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 8674
Mailing Address - Street 2:1230 E MAIN ST MANKATO CLINIC LTD
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-8674
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1421 PREMIER DR
Practice Address - Street 2:MANKATO CLINIC AT WICKERSHAM CAMPUS
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-625-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7567231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1832781OtherAMERICAS PPO
MN026K9OLOtherBCBS
MN086605900Medicaid
640004790OtherRR MEDICARE
MNNA2951023870OtherPREFERRED ONE
41084933956001C208OtherCHAMPUS
MN4500237OtherMEDICA
MNHP40596OtherHEALTH PARTNERS
MN1832781OtherAMERICAS PPO