Individual
LACEY BOURGOIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP-A
Contact information
Practice address
17 SCHOOL ST, RANDOLPH, ME 04346-5143
(207) 588-2699
Mailing address
17 SCHOOL ST, RANDOLPH, ME 04346-5143
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
BH001153
PA
2355S0801X
Speech-Language Assistant
Primary
—
—
Other
Enumeration date
08/14/2014
Last updated
08/21/2024
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