Provider Demographics
NPI:1659523504
Name:BIONDO, LACEY HEBERT (SLP)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:HEBERT
Last Name:BIONDO
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 1:1713 RIDGEFIELD RD STE C
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4399
Mailing Address - Country:US
Mailing Address - Phone:985-449-0944
Mailing Address - Fax:
Practice Address - Street 1:1713 RIDGEFIELD RD STE C
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4399
Practice Address - Country:US
Practice Address - Phone:985-449-0944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5789235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist