Healthcare Provider Details

I. General information

NPI: 1962011197
Provider Name (Legal Business Name): LACEE HAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1884 NE COUNTY ROAD 5004
BUTLER MO
64730-8684
US

IV. Provider business mailing address

6488 NW STATE ROUTE 18
ADRIAN MO
64720-4805
US

V. Phone/Fax

Practice location:
  • Phone: 660-227-1257
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2024035981
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: