Healthcare Provider Details

I. General information

NPI: 1386568301
Provider Name (Legal Business Name): WILLIAM JOSEPH LACKEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1137 HYACINTH AVE E
SAINT PAUL MN
55106-2041
US

IV. Provider business mailing address

1137 HYACINTH AVE E
SAINT PAUL MN
55106-2041
US

V. Phone/Fax

Practice location:
  • Phone: 757-775-5315
  • Fax:
Mailing address:
  • Phone: 757-775-5315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: