Individual
LACIE L YBARRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
2616 AVENUE A, SCOTTSBLUFF, NE 69361-1635
(308) 672-5759
Mailing address
90 SPRING VALLEY LN, GERING, NE 69341-1622
(231) 903-5499
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1543
NE
235Z00000X
Speech-Language Pathologist
2013029466
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578997458
—
NE
Enumeration date
08/27/2013
Last updated
05/06/2019
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