Individual
LACEY JANE STATON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP
Contact information
Practice address
1335 MARIA LN, AVON, IN 46123-8012
(317) 965-0694
Mailing address
1335 MARIA LN, AVON, IN 46123-8012
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22004563A
IN
Other
Enumeration date
09/14/2009
Last updated
09/14/2009
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