Provider Demographics
NPI:1881948297
Name:LEE, TRACY (CCC-SLP/ATP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:CCC-SLP/ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S ORANGE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5804
Mailing Address - Country:US
Mailing Address - Phone:973-763-9900
Mailing Address - Fax:973-763-9905
Practice Address - Street 1:220 S ORANGE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5804
Practice Address - Country:US
Practice Address - Phone:973-763-9900
Practice Address - Fax:973-763-9905
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00362700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist