Provider Demographics
NPI:1598535080
Name:LAZENBY, CHRISTAL GRACE (BA)
Entity Type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:GRACE
Last Name:LAZENBY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:CHRISTAL
Other - Middle Name:GRACE
Other - Last Name:LAUDERBACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA
Mailing Address - Street 1:90 HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8138
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:508 AUTUMN SPRINGS CT STE 1A
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8274
Practice Address - Country:US
Practice Address - Phone:909-809-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant