Individual
LACIE DEANN BRUICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSCCCSLP
Contact information
Practice address
313 ELIZABETH ST, CONWAY, AR 72034-6335
(501) 744-0329
Mailing address
313 ELIZABETH ST, CONWAY, CONWAY, AR 72034-6335
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP#3089
AR
Other
Enumeration date
12/14/2011
Last updated
07/09/2012
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