Individual
LACEE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5025 E WASHINGTON STREET, SUITE 212, PHOENIX, AZ 85034
(602) 773-5773
Mailing address
4131 E. MAYA WAY, CAVE CREEK, AZ 85331-3181
(618) 922-4246
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
5135
TN
235Z00000X
Speech-Language Pathologist
Primary
9357
AZ
Other
Enumeration date
12/01/2014
Last updated
12/14/2016
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