Provider Demographics
NPI:1760043384
Name:LECZNAR, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:LECZNAR
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 1:7110 MICHIGAN RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9310
Mailing Address - Country:US
Mailing Address - Phone:989-980-9747
Mailing Address - Fax:888-527-3589
Practice Address - Street 1:7110 MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9310
Practice Address - Country:US
Practice Address - Phone:989-980-9747
Practice Address - Fax:888-527-3589
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101006316235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist