Provider Demographics
NPI:1447478763
Name:PENNEY, TRACY MOWDY (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:MOWDY
Last Name:PENNEY
Suffix:
Gender:F
Credentials:MS 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:RR 1 BOX 857
Mailing Address - Street 2:
Mailing Address - City:COALGATE
Mailing Address - State:OK
Mailing Address - Zip Code:74538-9719
Mailing Address - Country:US
Mailing Address - Phone:580-927-2327
Mailing Address - Fax:
Practice Address - Street 1:COAL COUNTY GENERAL HOSPITAL, PT DEPT
Practice Address - Street 2:6 NORTH COVINGTON
Practice Address - City:COALGATE
Practice Address - State:OK
Practice Address - Zip Code:74538
Practice Address - Country:US
Practice Address - Phone:580-927-2327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2487235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist