Provider Demographics
NPI:1740423268
Name:YEOMANS, LACEY N (M ED CCC/SLP)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:N
Last Name:YEOMANS
Suffix:
Gender:F
Credentials:M ED CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1281 CLIFFORD LOOP
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-5917
Mailing Address - Country:US
Mailing Address - Phone:912-387-6126
Mailing Address - Fax:
Practice Address - Street 1:3891 QUAIL HOLLOW VILLAGE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31535
Practice Address - Country:US
Practice Address - Phone:912-331-0846
Practice Address - Fax:912-331-0847
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007059235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist