Provider Demographics
NPI:1457784134
Name:LACEFIELD, JACKLYNN TEAL NEUTZ (AUD)
Entity type:Individual
Prefix:
First Name:JACKLYNN
Middle Name:TEAL NEUTZ
Last Name:LACEFIELD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JACKLYNN
Other - Middle Name:TEAL
Other - Last Name:NEUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:729 SPECKMAN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1876
Mailing Address - Country:US
Mailing Address - Phone:502-539-5000
Mailing Address - Fax:
Practice Address - Street 1:729 SPECKMAN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1876
Practice Address - Country:US
Practice Address - Phone:502-539-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY267989231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist