Provider Demographics
NPI:1639469612
Name:LAZICH, MARY KATHLEEN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHLEEN
Last Name:LAZICH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:BARNARDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28709-0054
Mailing Address - Country:US
Mailing Address - Phone:901-262-6503
Mailing Address - Fax:
Practice Address - Street 1:272 PAINT FORK RD
Practice Address - Street 2:
Practice Address - City:BARNARDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28709-9765
Practice Address - Country:US
Practice Address - Phone:901-262-6503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist