Provider Demographics
NPI:1639425010
Name:ROBINSON, LACY K (SPEECH-LANGUAGE PATH)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:K
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 E SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-2092
Mailing Address - Country:US
Mailing Address - Phone:814-244-4983
Mailing Address - Fax:
Practice Address - Street 1:3308 E SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-2092
Practice Address - Country:US
Practice Address - Phone:814-244-4983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE01-0001334235Z00000X
PASL010598235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist