Provider Demographics
NPI:1285050898
Name:STEWART, LACY JANELLE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:JANELLE
Last Name:STEWART
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:LACY
Other - Middle Name:JANELLE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:147 COUNTY HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-3315
Mailing Address - Country:US
Mailing Address - Phone:607-435-9060
Mailing Address - Fax:
Practice Address - Street 1:99 MAIN ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:NY
Practice Address - Zip Code:13753-1221
Practice Address - Country:US
Practice Address - Phone:607-832-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023503235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist