Provider Demographics
NPI:1861536070
Name:DEMMON, TRACEY JEAN (AUD)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:JEAN
Last Name:DEMMON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4904
Mailing Address - Country:US
Mailing Address - Phone:360-738-3958
Mailing Address - Fax:360-738-4287
Practice Address - Street 1:1321 KING ST STE 2
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-6237
Practice Address - Country:US
Practice Address - Phone:360-738-3958
Practice Address - Fax:360-738-4287
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9295205Medicaid