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NPI Code Detail

MEDICARE: ALLISON PIERCE LACKEY

MEDICARE:   ALLISON PIERCE LACKEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist9980NC

General Provider Information

NPI Number : 1134477961
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLISON PIERCE LACKEY
Provider Business Mailing Address
First Line : 2362 PEARTREE RD
Second Line :
City : ELIZABETH CITY
State : NC
Zip : 27909-7276
Country : US
Telephone Number : 252-331-3337
Fax Number :
Provider Business Practice Location Address
First Line : 2362 PEARTREE RD
Second Line :
City : ELIZABETH CITY
State : NC
Zip : 27909-7276
Country : US
Telephone Number : 252-331-3337
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2012
Last Update Date : 09/02/2022

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Directions to “ ALLISON PIERCE LACKEY ” Practice Location

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