Provider Demographics
NPI:1558617209
Name:EGAN, LACEY ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:ANN
Last Name:EGAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:ANN
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:4255 E PECOS RD APT 1043
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-7845
Mailing Address - Country:US
Mailing Address - Phone:801-856-4342
Mailing Address - Fax:
Practice Address - Street 1:1753 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-3617
Practice Address - Country:US
Practice Address - Phone:801-856-4342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP7868235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist