MEDICARE: LACEE DANIELLE BLACKSTONE

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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1710821483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACEE DANIELLE BLACKSTONE

Provider Business Mailing Address
First Line	:	2549 N STOKESBERRY PL
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-1144
Country	:	US
Telephone Number	:	478-449-5275
Fax Number	:

Provider Business Practice Location Address
First Line	:	2549 N STOKESBERRY PL
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-1144
Country	:	US
Telephone Number	:	478-449-5275
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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Directions to “ LACEE DANIELLE BLACKSTONE ” Practice Location

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