Basic Information
| Provider Information | |||||||||
| NPI: | 1487676326 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COWMAN | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AU.D., CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4101 S 4TH ST | ||||||||
| Address2: | AUDIOLOGY AND SPEECH #L-126 | ||||||||
| City: | LEAVENWORTH | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660485014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136822000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4101 S 4TH ST | ||||||||
| Address2: | AUDIOLOGY AND SPEECH #L-126 | ||||||||
| City: | LEAVENWORTH | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660485014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136822000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2006 | ||||||||
| LastUpdateDate: | 11/15/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 1964 AUD 1182 HA | KS | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | 115409 | 01 | KS | BLUE CROSS BLUE SHIELD | OTHER |