Provider Demographics
NPI:1871626861
Name:RICHARD W. LAZICH, AU.D. PLLC
Entity type:Organization
Organization Name:RICHARD W. LAZICH, AU.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-345-8375
Mailing Address - Street 1:4135 SHELBYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3203
Mailing Address - Country:US
Mailing Address - Phone:502-890-3921
Mailing Address - Fax:502-890-3923
Practice Address - Street 1:4135 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3203
Practice Address - Country:US
Practice Address - Phone:502-890-3921
Practice Address - Fax:502-890-3923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0066231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000388061OtherANTHEM