Provider Demographics
NPI:1841566130
Name:MEENAGHAN, LACEY KAHNER (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:KAHNER
Last Name:MEENAGHAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-3120
Mailing Address - Country:US
Mailing Address - Phone:609-213-0794
Mailing Address - Fax:
Practice Address - Street 1:2415 RIVIERA DR
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22181-3120
Practice Address - Country:US
Practice Address - Phone:609-213-0794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005721235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist