Provider Demographics
NPI:1770361271
Name:LACEY GARITA, DORIAN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DORIAN
Middle Name:
Last Name:LACEY GARITA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 E ENGLER ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5551
Mailing Address - Country:US
Mailing Address - Phone:614-299-4554
Mailing Address - Fax:614-670-7427
Practice Address - Street 1:523 E ENGLER ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5551
Practice Address - Country:US
Practice Address - Phone:614-299-4554
Practice Address - Fax:614-670-7427
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.15600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist