Provider Demographics
NPI:1639663099
Name:GULLING, LACEY SEAWRIGHT (SLP)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:SEAWRIGHT
Last Name:GULLING
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 1:1007 GOODYEAR AVE
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1100
Mailing Address - Country:US
Mailing Address - Phone:256-413-6060
Mailing Address - Fax:256-413-6066
Practice Address - Street 1:1007 GOODYEAR AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1100
Practice Address - Country:US
Practice Address - Phone:256-413-6060
Practice Address - Fax:256-413-6066
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4309235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist