Active NPI
Tracy Spitzack, SLP
- Speech-Language Pathologist
- Blaine, MN
National Provider Identifier
1003372012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 9902
- Practice address
- 12450 Cloud Dr NE
Blaine, MN 55449-6274 - Phone
- (763) 777-7117
- Fax
- (651) 401-0598
- NPI assigned
- Feb 14, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 9902 | MN | Primary |
Addresses
Primary practice location
12450 Cloud Dr NE
Blaine, MN 55449-6274
Mailing address
12450 Cloud Dr NE
Blaine, MN 55449-6274
Phone (763) 777-7117
Other names 1
- Tracy Mueller
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9902 | MN | MD | Orthopedic Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550102400000",
"number": "1003372012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12450 CLOUD DR NE",
"city": "BLAINE",
"state": "MN",
"postal_code": "554496274",
"telephone_number": "763-777-7117",
"fax_number": "651-401-0598"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12450 CLOUD DR NE",
"city": "BLAINE",
"state": "MN",
"postal_code": "554496274",
"telephone_number": "763-777-7117",
"fax_number": "651-401-0598"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPITZACK",
"first_name": "TRACY",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-14",
"last_updated": "2019-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MN",
"license": "9902",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "TRACY",
"last_name": "MUELLER",
"credential": "SLP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Blaine, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.