Provider Demographics
NPI:1689459687
Name:LACKNEY, ANNACLAIRE
Entity Type:Individual
Prefix:
First Name:ANNACLAIRE
Middle Name:
Last Name:LACKNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 RIDGEWOOD AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5059
Mailing Address - Country:US
Mailing Address - Phone:513-498-7324
Mailing Address - Fax:
Practice Address - Street 1:257A COUNTY ROAD 40
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:OH
Practice Address - Zip Code:44880-9731
Practice Address - Country:US
Practice Address - Phone:419-736-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20232581-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist