Provider Demographics
NPI:1639141898
Name:LACEY-MOREY, CARA R (SLP)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:R
Last Name:LACEY-MOREY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:RENEE
Other - Last Name:MOREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:550 NE SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-6147
Mailing Address - Country:US
Mailing Address - Phone:503-512-0825
Mailing Address - Fax:
Practice Address - Street 1:550 NE SCOTT AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-6147
Practice Address - Country:US
Practice Address - Phone:503-512-0825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12108235Z00000X
CA20932235Z00000X
ID2436235Z00000X
AZSLP7921235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1639141898Medicaid
CA1639141898Medicaid
ID1639141898Medicaid
OR182812Medicaid
OR838883002Medicare UPIN
AZ1639141898Medicaid
CA1639141898Medicare UPIN
AZ1639141898Medicare UPIN
CA1639141898Medicaid