Individual
MS. MISTY MICHELLE LACEWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
6124 NORTHMOOR DR, LITTLE ROCK, AR 72204-2504
(501) 614-7200
Mailing address
2401 BLACKWOOD RD, LITTLE ROCK, AR 72207
(501) 681-8148
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1730
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
137364721
—
AR
Enumeration date
04/07/2007
Last updated
04/23/2024
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