Provider Demographics
NPI:1598357428
Name:PASQUALE, LACY LEE (MS/SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:LACY
Middle Name:LEE
Last Name:PASQUALE
Suffix:
Gender:F
Credentials:MS/SLP-CCC
Other - Prefix:MISS
Other - First Name:LACY
Other - Middle Name:LEE
Other - Last Name:NICKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS/SLP-CCC
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:PERRYSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47974-0191
Mailing Address - Country:US
Mailing Address - Phone:765-505-1447
Mailing Address - Fax:
Practice Address - Street 1:450 8TH AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4030
Practice Address - Country:US
Practice Address - Phone:812-238-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22005287A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist