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General NPI Number Information
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NPI Number | 1619850633
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Entity Type | Individual
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Provider Name | LACY GRACE PETTY SLP
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Gender | Female
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Dates
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Enumeration Date | 07/28/2025
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 600 S TYLER ST. CHASE TOWER #805
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City | AMARILLO
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State | TX
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Zip | 79101
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Country | US
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Telephone | 806-553-7780
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 201
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City | ADRIAN
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State | TX
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Zip | 79001-0201
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 123604
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License Number State | TX
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