1447914007 NPI number — TRACY CAMILLE JOHNSON M.S., CCC-SLP, CLC

Table of content: TRACY CAMILLE JOHNSON M.S., CCC-SLP, CLC (NPI 1447914007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447914007 NPI number — TRACY CAMILLE JOHNSON M.S., CCC-SLP, CLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
TRACY
Provider Middle Name:
CAMILLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-SLP, CLC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447914007
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7302 CRYSTALBROOK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78724-3313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-537-3136
Provider Business Mailing Address Fax Number:
512-222-4330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7302 CRYSTALBROOK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78724-3313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-537-3136
Provider Business Practice Location Address Fax Number:
512-222-4330
Provider Enumeration Date:
10/28/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174N00000X , with the licence number:  352442 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 117491 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 117491 . This is a "TDLR- SLP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1414916 . This is a "ASHA- CCC" identifier . This identifiers is of the category "OTHER".




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