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General NPI Number Information
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NPI Number | 1841347911
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Entity Type | Individual
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Provider Name | LACEY MARIE HALLECK L.M.P.
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Gender | Female
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 151 N MARKET BLVD STE B
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City | CHEHALIS
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State | WA
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Zip | 98532-2677
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Country | US
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Telephone | 360-740-9714
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Fax | 360-740-4879
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Provider Business Mailing Address
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Address Line | 2739 HEMLOCK ST
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City | LONGVIEW
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State | WA
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Zip | 98632-2046
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Country | US
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Telephone | 360-740-9714
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Fax | 360-740-4879
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00021920
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License Number State | WA
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