Individual
LACEY CLEVELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
2600 WILSON ST, MILES CITY, MT 59301-5094
(406) 233-2719
Mailing address
4905 S BAY DR SE, MANDAN, ND 58554-4747
(605) 645-0631
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
1158
ND
235Z00000X
Speech-Language Pathologist
Primary
1294
MT
235Z00000X
Speech-Language Pathologist
3141
KS
Other
Enumeration date
06/28/2011
Last updated
06/28/2011
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