Tracy M Anderson

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

014898-1 Issued in NY

Practice address

1012 Tabor PL
Utica, NY 13502-3642

Phone

(315) 797-1398

NPI assigned

Mar 15, 2010

Last updated

Jan 30, 2015By 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

Other identifiers 2

Other names 1

• Ms. Tracy A Mullen Former name

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": "1268611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422576000000",
    "number": "1285958504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 TABOR PL",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135023642",
            "telephone_number": "315-797-1398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 TABOR PL",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135023642",
            "telephone_number": "315-797-1398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "TRACY",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-15",
        "last_updated": "2015-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "014898-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01815443",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00313539",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACY",
            "last_name": "MULLEN",
            "middle_name": "A",
            "prefix": "MS.",
            "credential": "SPL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mary Kathleen Amidon
• Noura Amin, MD
• Almedin Andelija, RPH
• Harold Lyle Anderson, LCSW
• Stephanie Anderson
• Andrew Carucci
• Christine M Andrews
• Joshua Appley, LMSW
• Peter Jocson Arches, MD
• Kathleen H. Arcuri, SPLP

• Speech-Language Pathologist in Utica, NY
• Providers in Utica, NY by specialty
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2015; 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.