Provider Demographics
NPI:1215672522
Name:PENTICUFF, LACEY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:PENTICUFF
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:MARIE
Other - Last Name:BARKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:70 UNIONVILLE FEURA BUSH RD
Mailing Address - Street 2:
Mailing Address - City:FEURA BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12067-1808
Mailing Address - Country:US
Mailing Address - Phone:518-388-3730
Mailing Address - Fax:
Practice Address - Street 1:500 BALLTOWN RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-2247
Practice Address - Country:US
Practice Address - Phone:518-388-3730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030580235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist