Tracey J Widrick, SLP CCC TSSLD

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Practice address

15050 14TH Rd
Whitestone, NY 11357-2609

Phone

(718) 767-0071

NPI assigned

Oct 31, 2018

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1540944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587340800000",
    "number": "1497222178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 HUNTERS GLN",
            "city": "FAR HILLS",
            "state": "NJ",
            "postal_code": "079312215",
            "telephone_number": "516-376-8396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15050 14TH RD",
            "city": "WHITESTONE",
            "state": "NY",
            "postal_code": "113572609",
            "telephone_number": "718-767-0071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDRICK",
        "first_name": "TRACEY",
        "middle_name": "J",
        "credential": "SLP CCC TSSLD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-31",
        "last_updated": "2020-04-20",
        "certification_date": "2020-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Whitestone, NY
• Providers in Whitestone, 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 Apr 20, 2020; 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.