Provider Demographics
NPI:1275177297
Name:MELVIN, LACY HARSEY (MSP, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:HARSEY
Last Name:MELVIN
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 POWER POINT LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7662
Mailing Address - Country:US
Mailing Address - Phone:803-206-5530
Mailing Address - Fax:
Practice Address - Street 1:259 RIVER RIDGE WAY
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:SC
Practice Address - Zip Code:29160-8287
Practice Address - Country:US
Practice Address - Phone:803-622-4482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5430235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist