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Individual

LACY BOUTWELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
524 S HOUSTON LAKE RD STE B300, WARNER ROBINS, GA 31088-9042
(678) 910-3940
(404) 464-0819
Mailing address
107 GRAND VIEW AVE, KATHLEEN, GA 31047-2747
(678) 910-3940
(404) 464-0819

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP008941
GA

Other

Enumeration date
10/19/2018
Last updated
10/19/2018
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