Individual
TRACIE A GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP,CCC
Contact information
Practice address
40 S 2ND ST, OAKLAND, MD 21550-1518
(301) 334-8900
Mailing address
40 S 2ND ST, OAKLAND, MD 21550-1518
(301) 334-8900
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
04797
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
186300200
—
MD
Enumeration date
09/29/2009
Last updated
01/11/2019
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