MEDICARE: LACEY MARIE CLAPPER LLMSW

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	104100000X	Social Worker	6801105576	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6801105576	OTHER	MI	STATE OF MICHIGAN
2	6801105576	OTHER	MI	STATE OF MICHIGAN LICENSE

General Provider Information

NPI Number	:	1851911978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACEY MARIE CLAPPER LLMSW

Provider Business Mailing Address
First Line	:	1536 GULL RD
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49048-1621
Country	:	US
Telephone Number	:	269-762-0133
Fax Number	:

Provider Business Practice Location Address
First Line	:	1536 GULL RD
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49048-1621
Country	:	US
Telephone Number	:	269-373-6000
Fax Number	:

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

Provider Enumeration Date	:	04/18/2020
Last Update Date	:	12/11/2020

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