Healthcare Provider Details

I. General information

NPI: 1295645711
Provider Name (Legal Business Name): LACEY M DEVENNEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 31001-4166
PASADENA CA
91110-4166
US

IV. Provider business mailing address

1666 CACHE DR
ANCHORAGE AK
99507-1326
US

V. Phone/Fax

Practice location:
  • Phone: 866-747-2455
  • Fax:
Mailing address:
  • Phone: 907-308-2694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number248312
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: