Provider Demographics
NPI:1285402628
Name:SMITH, LACIE
Entity type:Individual
Prefix:
First Name:LACIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 241
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43115-0241
Mailing Address - Country:US
Mailing Address - Phone:174-099-3821
Mailing Address - Fax:
Practice Address - Street 1:10942 6TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:OH
Practice Address - Zip Code:43115-7513
Practice Address - Country:US
Practice Address - Phone:740-993-8211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant