Healthcare Provider Details

I. General information

NPI: 1235068685
Provider Name (Legal Business Name): LACEY MARIE SELMAN LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 E RIVER RD
OSCODA MI
48750-9025
US

IV. Provider business mailing address

520 S LORENZ RD
TAWAS CITY MI
48763-9801
US

V. Phone/Fax

Practice location:
  • Phone: 989-739-9121
  • Fax:
Mailing address:
  • Phone: 989-296-9624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6851121875
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851121875
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: