Provider Demographics
NPI:1689480949
Name:TERRALL, TRACY JANEL (CCC-SLP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:JANEL
Last Name:TERRALL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:FREISTAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3781 HONOLULU AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-1031
Mailing Address - Country:US
Mailing Address - Phone:541-954-3535
Mailing Address - Fax:
Practice Address - Street 1:3781 HONOLULU AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-1031
Practice Address - Country:US
Practice Address - Phone:541-954-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist