Provider Demographics
NPI:1235713363
Name:ROBERTS, LACEY ROSE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:ROSE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4890 UNIVERSITY SQ STE 7
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35816-1896
Mailing Address - Country:US
Mailing Address - Phone:256-294-1685
Mailing Address - Fax:
Practice Address - Street 1:103 INTERCOM DR STE C
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2641
Practice Address - Country:US
Practice Address - Phone:256-464-9464
Practice Address - Fax:256-325-9469
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2023-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist