Provider Demographics
NPI:1184744583
Name:DUPLER, TRACI SHRIDER (MA CCC SLP)
Entity type:Individual
Prefix:MS
First Name:TRACI
Middle Name:SHRIDER
Last Name:DUPLER
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43056-9372
Mailing Address - Country:US
Mailing Address - Phone:740-323-2514
Mailing Address - Fax:
Practice Address - Street 1:1035 BEVERLY AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1414
Practice Address - Country:US
Practice Address - Phone:740-453-5417
Practice Address - Fax:740-453-5480
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 4070235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0899943Medicaid
OH1093785784OtherCARR CENTER'S NPI