Provider Demographics
NPI:1295961753
Name:BROOKS, LACEY (AUD)
Entity type:Individual
Prefix:DR
First Name:LACEY
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 SPRING CYPRESS RD
Mailing Address - Street 2:STE 105
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3354
Mailing Address - Country:US
Mailing Address - Phone:281-444-9800
Mailing Address - Fax:281-257-1594
Practice Address - Street 1:8515 SPRING CYPRESS RD
Practice Address - Street 2:STE 105
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3354
Practice Address - Country:US
Practice Address - Phone:281-444-9800
Practice Address - Fax:281-257-1594
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80148231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010812882OtherTIN