Provider Demographics
NPI:1972085009
Name:LACENERE, ANITA (MACCC/SLP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:LACENERE
Suffix:
Gender:F
Credentials:MACCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MORNING MIST DR
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-1490
Mailing Address - Country:US
Mailing Address - Phone:412-583-2980
Mailing Address - Fax:
Practice Address - Street 1:951 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-2349
Practice Address - Country:US
Practice Address - Phone:412-583-2980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005162L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist