Individual
LACEY QUINBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
4259 OAK FOREST DR, VALDOSTA, GA 31602-0854
(229) 329-7409
Mailing address
4259 OAK FOREST DR, VALDOSTA, GA 31602-0854
(229) 329-7409
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
010905
GA
235Z00000X
Speech-Language Pathologist
PCET002791
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47-2746468
—
GA
Enumeration date
09/19/2018
Last updated
06/05/2024
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