Provider Demographics
NPI:1790290450
Name:ANDERSON, LACEY SNOW (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:SNOW
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MISS
Other - First Name:LACEY
Other - Middle Name:SNOW
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:1816 PINNACLE LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-4678
Mailing Address - Country:US
Mailing Address - Phone:405-209-9986
Mailing Address - Fax:
Practice Address - Street 1:1901 W 15TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-2689
Practice Address - Country:US
Practice Address - Phone:405-726-7465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4566235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist