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General NPI Number Information
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NPI Number | 1316669104
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Entity Type | Organization
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Legal Business Name | ABRA LACY SPEECH SOLUTIONS, LLC
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 238 ALBANY AVE
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City | LOUISVILLE
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State | KY
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Zip | 40206-2845
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Country | US
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Telephone | 502-554-8961
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Fax |
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Provider Business Mailing Address
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Address Line | 238 ALBANY AVE
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City | LOUISVILLE
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State | KY
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Zip | 40206-2845
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Country | US
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Telephone | 502-554-8961
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Fax |
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Authorized Official
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Title or Position | OWNER, SLP
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Name | ABRA MARCUM LACY
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Credential | M.S., CCC-SLP
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Telephone | 502-554-8961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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