Provider Demographics
NPI:1194503292
Name:BABCOCK, LACI ANNE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:LACI
Middle Name:ANNE
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W PLUMB ST
Mailing Address - Street 2:
Mailing Address - City:LEON
Mailing Address - State:KS
Mailing Address - Zip Code:67074-9645
Mailing Address - Country:US
Mailing Address - Phone:469-337-6473
Mailing Address - Fax:
Practice Address - Street 1:LACI BABCOCK
Practice Address - Street 2:300 W PLUMB ST
Practice Address - City:LEON
Practice Address - State:KS
Practice Address - Zip Code:67074
Practice Address - Country:US
Practice Address - Phone:469-337-6473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3439235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist