Tracey Michelle Dobusch, MS, CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Lakeport, CA
NPI 1124649082 · NPPES record last updated May 1, 2020
Key facts
- NPI
- 1124649082
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- SP9688 (CA)
- Practice address
- 150 Lange St
Lakeport, CA 95453-3297 - Phone
- (707) 262-3019
- NPI assigned
- May 1, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP9688 | CA | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP9688 | CA | Yes |
Addresses
Primary practice location
150 Lange St
Lakeport, CA 95453-3297
Mailing address
7155 Kelsey Creek Dr
Kelseyville, CA 95451-8024
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SP9688 | Other | CA | SPEECH PATHOLOGY LICENSE |
Other providers in Lakeport, CA
- Samantha Dean
- Bruce David Deas
- Alma Olga Delgado
- Joan Devito
- Richard Allan Diwald
- Elyse Midori Donald
- Keith Phillip Donald
- Jonathan Michael Drew
- Kathleen E Duchene
- Marlin Noelia Duran
All providers in Lakeport, CA · Speech-Language Pathologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.