Individual
MRS. TRACY IRANSHAHR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
TRACY
Contact information
Practice address
2745 N BLACK ROCK RD, BUCKEYE, AZ 85396-1813
(623) 537-7224
Mailing address
2745 N BLACK ROCK RD, BUCKEYE, AZ 85396-1813
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
SLPA10666
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D04163830
DRIVERS LICENSE
AZ
Enumeration date
11/22/2017
Last updated
11/22/2017
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