Tracey Lynn Wallace, AU.D., CCC/A

Primary specialty

Audiologist-Hearing Aid FitterTaxonomy code 237600000X

License

00718 Issued in MD

Practice address

14101 Molly Berry Rd
Brandywine, MD 20613-2306

Phone

(301) 793-3277

NPI assigned

Jul 9, 2008

Last updated

Oct 16, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381881600000",
    "number": "1144483033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6368 COVENTRY WAY",
            "address_2": "SUITE #146",
            "city": "CLINTON",
            "state": "MD",
            "postal_code": "207352256",
            "telephone_number": "301-793-3277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14101 MOLLY BERRY RD",
            "city": "BRANDYWINE",
            "state": "MD",
            "postal_code": "206132306",
            "telephone_number": "301-793-3277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TRACEY",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "AU.D., CCC/A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-09",
        "last_updated": "2013-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "MD",
            "license": "00718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Audiologist-Hearing Aid Fitter in Brandywine, MD
• Providers in Brandywine, MD by specialty
• Audiologist-Hearing Aid Fitter in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.