Provider Demographics
NPI:1356985402
Name:HINZMAN, LACEE (SLP)
Entity type:Individual
Prefix:
First Name:LACEE
Middle Name:
Last Name:HINZMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:LACEE
Other - Middle Name:
Other - Last Name:LAURITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 ROCKEFELLER CIR
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:WV
Mailing Address - Zip Code:26047-9435
Mailing Address - Country:US
Mailing Address - Phone:304-364-3411
Mailing Address - Fax:
Practice Address - Street 1:130 ROCKEFELLER CIR
Practice Address - Street 2:
Practice Address - City:NEW CUMBERLAND
Practice Address - State:WV
Practice Address - Zip Code:26047-9435
Practice Address - Country:US
Practice Address - Phone:304-364-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-2032235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist