Provider Demographics
NPI:1265571798
Name:HOUSKA, LACY D (SLP)
Entity type:Individual
Prefix:MRS
First Name:LACY
Middle Name:D
Last Name:HOUSKA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2099 E 875 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62565-4214
Mailing Address - Country:US
Mailing Address - Phone:217-774-1456
Mailing Address - Fax:
Practice Address - Street 1:2099 E 875 NORTH RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565-4214
Practice Address - Country:US
Practice Address - Phone:217-774-1456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.005606235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist