Provider Demographics
NPI:1962968750
Name:HATHCOCK, LACI (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:LACI
Middle Name:
Last Name:HATHCOCK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:LACI
Other - Middle Name:
Other - Last Name:DEARDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:11750 E POWERS AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4139
Mailing Address - Country:US
Mailing Address - Phone:303-995-6259
Mailing Address - Fax:
Practice Address - Street 1:11750 E POWERS AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80111-4139
Practice Address - Country:US
Practice Address - Phone:303-995-6259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-16
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12123658235Z00000X
CO151648235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist