MEDICARE: MRS. LACEY DUGAS HUNDLEY

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	7214	LA

General Provider Information

NPI Number	:	1861842791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LACEY DUGAS HUNDLEY

Provider Business Mailing Address
First Line	:	2601 AIRLINE DR
Second Line	:	APT 311
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-5854
Country	:	US
Telephone Number	:	337-962-0778
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 AIRLINE DR
Second Line	:	APT 311
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-5854
Country	:	US
Telephone Number	:	337-962-0778
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2016
Last Update Date	:	06/22/2016

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