Provider Demographics
NPI:1295090777
Name:SANDERS, LACEY (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:
Other - Last Name:NUNNALLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1900 ALDERSGATE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6620
Mailing Address - Country:US
Mailing Address - Phone:501-821-5459
Mailing Address - Fax:
Practice Address - Street 1:1900 ALDERSGATE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6620
Practice Address - Country:US
Practice Address - Phone:501-821-5459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#3148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist