Individual
JARED TRACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CCC-SLP
Contact information
Practice address
1801 POPLAR DR APT 64, MEDFORD, OR 97504-4677
(503) 939-3445
Mailing address
1801 POPLAR DR APT 64, MEDFORD, OR 97504-4677
(503) 939-3445
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
15138
OR
Other
Enumeration date
05/27/2015
Last updated
05/27/2015
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