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NPI Code Detail

MEDICARE: LACEY SUZANNE O'CONNOR BS, MHP

MEDICARE: LACEY SUZANNE O'CONNOR BS, MHP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1184728651
Entity Type Code : Individual
Provider Name (Legal Business Name) : LACEY SUZANNE O'CONNOR BS, MHP
Provider Business Mailing Address
First Line : PO BOX 144
Second Line :
City : NEW CANTON
State : IL
Zip : 62356-0144
Country : US
Telephone Number : 217-223-0413
Fax Number :
Provider Business Practice Location Address
First Line : 4409 MAINE ST
Second Line :
City : QUINCY
State : IL
Zip : 62305-5849
Country : US
Telephone Number : 217-223-0423
Fax Number : 217-223-0461
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2006
Last Update Date : 07/08/2007

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