Provider Demographics
NPI:1538500376
Name:WIDNER, TRACIE JENNIFER (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:JENNIFER
Last Name:WIDNER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:TRACIE
Other - Middle Name:JENNIFER
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2190 WINFIELD DUNN PKWY
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37876-0502
Mailing Address - Country:US
Mailing Address - Phone:865-280-2799
Mailing Address - Fax:865-366-2384
Practice Address - Street 1:2190 WINFIELD DUNN PKWY
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37876-0502
Practice Address - Country:US
Practice Address - Phone:865-280-2799
Practice Address - Fax:865-366-2384
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003613235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist