MEDICARE: LAC ASSOCIATES LLC

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
1	235Z00000X	Speech-Language Pathologist	SA11455	FL

General Provider Information

NPI Number	:	1518352301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAC ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	9465 WICKHAM WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32836-5521
Country	:	US
Telephone Number	:	954-224-1760
Fax Number	:

Provider Business Practice Location Address
First Line	:	9465 WICKHAM WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32836-5521
Country	:	US
Telephone Number	:	954-224-1760
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CONSTANTINE LINDSEY
Credential	:	MA, CCC-SLP
Telephone Number	:	954-224-1760

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	03/30/2015

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Directions to “LAC ASSOCIATES LLC ” Practice Location

Language	Start Address	Practice Location

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