Provider Demographics
NPI:1174003461
Name:DAUSH, LACEY (MA,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:
Last Name:DAUSH
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:NICOLE
Other - Last Name:HOPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2280 HIGHWAY 29 N
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1031
Mailing Address - Country:US
Mailing Address - Phone:770-683-6904
Mailing Address - Fax:
Practice Address - Street 1:2280 HIGHWAY 29 N
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265
Practice Address - Country:US
Practice Address - Phone:770-683-6834
Practice Address - Fax:770-252-0886
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010044235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist