Individual
MICHELLE RENEE TRACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
315 E QUEEN ST, PENDLETON, SC 29670-1721
(864) 403-2309
Mailing address
315 E QUEEN ST, PENDLETON, SC 29670-1721
(864) 403-2309
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
744
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942275649
—
SC
Enumeration date
01/14/2013
Last updated
09/24/2013
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