Provider Demographics
NPI:1114067709
Name:CRAIN, LACHELLE LYNN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LACHELLE
Middle Name:LYNN
Last Name:CRAIN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-1520
Mailing Address - Country:US
Mailing Address - Phone:573-445-4518
Mailing Address - Fax:
Practice Address - Street 1:3315 BERRYWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6571
Practice Address - Country:US
Practice Address - Phone:573-875-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113836235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist