Provider Demographics
NPI:1417759994
Name:LACY, KARA R
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:R
Last Name:LACY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6737 W WASHINGTON ST STE 3115
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-5651
Mailing Address - Country:US
Mailing Address - Phone:414-256-0077
Mailing Address - Fax:414-256-0090
Practice Address - Street 1:6737 W WASHINGTON ST STE 3115
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-5651
Practice Address - Country:US
Practice Address - Phone:414-256-0077
Practice Address - Fax:414-256-0090
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1369-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst