Provider Demographics
NPI:1184347163
Name:RYDER, LACEY
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:RYDER
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 1:195 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:RUMNEY
Mailing Address - State:NH
Mailing Address - Zip Code:03266-3413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:195 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:RUMNEY
Practice Address - State:NH
Practice Address - Zip Code:03266-3413
Practice Address - Country:US
Practice Address - Phone:603-786-9591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2275235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist