Healthcare Provider Details

I. General information

NPI: 1457696288
Provider Name (Legal Business Name): LACEY M. FISK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LACEY MAE REED LCSW

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7818 MOLINE RD
WEBSTER WI
54893-8545
US

IV. Provider business mailing address

203 UNITED WAY DRIVE
FREDERIC WI
54837-8938
US

V. Phone/Fax

Practice location:
  • Phone: 715-866-8301
  • Fax: 715-866-8374
Mailing address:
  • Phone: 715-327-4322
  • Fax: 715-327-8509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8011-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: