| Doctor Name: | LACEY GRANT |
| NPI Number: | 1104220847 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 37876 |
| Business Practice Address: | 3145 Denton Hwy Haltom City, TX - 761173710 |
| Business Phone Number: | 8178311078 |
| Business Fax Number: | |
| Mailing Address: | 305 Ne Loop 280;, Business Tower 1, Suite 200 HURST |
| State: | TX |
| Postal Code: | 76053 |
| Phone Number: | 8172928787 |
| Fax Number: | 8177896849 |
| NPI Enumeration Date: | 10/09/2014 |
| NPI Last Update Date: | 10/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2355S0801X |
| License Number: | 37876 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Specialist/Technologist |
| Taxonomy Specialization: | Speech-Language Assistant |
| Taxonomy Definition: | |