Provider Demographics
NPI:1003957523
Name:LACEY, HEIDI MARIE (CCC SLP TSHH)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:MARIE
Last Name:LACEY
Suffix:
Gender:F
Credentials:CCC SLP TSHH
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:MARIE
Other - Last Name:ZLOKOVITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC SLP TSHH
Mailing Address - Street 1:87A WICKS RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4415
Mailing Address - Country:US
Mailing Address - Phone:631-858-9147
Mailing Address - Fax:
Practice Address - Street 1:29 PINEWOOD DR
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5612
Practice Address - Country:US
Practice Address - Phone:631-499-1237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013088235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist