Provider Demographics
NPI:1316241433
Name:PRITCHARD, LACEY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:PRITCHARD
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 1:762 JOHN STREAT RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-8642
Mailing Address - Country:US
Mailing Address - Phone:270-566-3323
Mailing Address - Fax:270-343-6059
Practice Address - Street 1:762 JOHN STREAT RD
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-8642
Practice Address - Country:US
Practice Address - Phone:270-566-3323
Practice Address - Fax:270-343-6059
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10-014235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist