Provider Demographics
NPI:1396482774
Name:SHUMWAY, LACEY
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:SHUMWAY
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 1:2009 W JAKES LN
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-0197
Mailing Address - Country:US
Mailing Address - Phone:801-549-7249
Mailing Address - Fax:
Practice Address - Street 1:2009 W JAKES LN
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-0197
Practice Address - Country:US
Practice Address - Phone:801-549-7249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist