Tracie Lynn Johnson, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146007016 Issued in IL

Practice address

5533 N Galena Rd
Peoria Heights, IL 61616-4447

Phone

(309) 682-5428

NPI assigned

Jul 7, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Tracie Lynn Stabler Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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  NPD (past)
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  • NPI 1720037138
  NPD (past)

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

{
    "created_epoch": "1373155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373155200000",
    "number": "1417398462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5533 N GALENA RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616164447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5533 N GALENA RD",
            "city": "PEORIA HEIGHTS",
            "state": "IL",
            "postal_code": "616164447",
            "telephone_number": "309-682-5428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TRACIE",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-07-07",
        "last_updated": "2013-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146007016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACIE",
            "last_name": "STABLER",
            "middle_name": "LYNN",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Heights Healthcare and Rehabilitation Centrellc
• Shelby Helmick
• Shelby Joy Hennenfent, M.A. CF-SLP
• Hope Counseling & Therapy Services, LCPC
• Corey R. Hopson, LCPC
• Mark D Jones
• Iype Joseph
• Stacy Kannenberg
• Colleen Marie Kennedy
• Jennifer Lynn Kroll

• Speech-Language Pathologist in Peoria Heights, IL
• Providers in Peoria Heights, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 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.