Provider Demographics
NPI:1174683429
Name:LAZICH, RICHARD (AUD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:LAZICH
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13403 FOREST SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-2077
Mailing Address - Country:US
Mailing Address - Phone:502-241-1350
Mailing Address - Fax:
Practice Address - Street 1:4135 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3203
Practice Address - Country:US
Practice Address - Phone:502-890-3921
Practice Address - Fax:502-890-3923
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2016-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002093A231H00000X
KY66231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200097020Medicaid
IN200097020Medicaid
KYK056000Medicare UPIN