Individual
MRS. TRACY FATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
1908 W MILHAM AVE, PORTAGE, MI 49024-1232
(269) 459-6212
Mailing address
1908 W MILHAM AVE, PORTAGE, MI 49024-1232
(269) 459-6212
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7101000804
MI
Other
Enumeration date
01/14/2018
Last updated
01/14/2018
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