Provider Demographics
NPI:1316603848
Name:LASECKI, ANGELA N (AUD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:N
Last Name:LASECKI
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2046 S. VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:IMLAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48444
Mailing Address - Country:US
Mailing Address - Phone:810-721-7274
Mailing Address - Fax:810-721-7275
Practice Address - Street 1:2046 S. VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:IMLAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48444
Practice Address - Country:US
Practice Address - Phone:810-721-7274
Practice Address - Fax:810-721-7275
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601001045231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist