Provider Demographics
NPI:1023438967
Name:HOBLITZELL, TRACEY LYNN (HIS)
Entity type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:LYNN
Last Name:HOBLITZELL
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1170
Mailing Address - Street 2:
Mailing Address - City:FORT ASHBY
Mailing Address - State:WV
Mailing Address - Zip Code:26719-1170
Mailing Address - Country:US
Mailing Address - Phone:304-298-4404
Mailing Address - Fax:304-298-4184
Practice Address - Street 1:10164 FRANKFORT HWY
Practice Address - Street 2:
Practice Address - City:FORT ASHBY
Practice Address - State:WV
Practice Address - Zip Code:26719-9276
Practice Address - Country:US
Practice Address - Phone:304-298-4404
Practice Address - Fax:304-298-4184
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02568237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist