Provider Demographics
NPI:1457696288
Name:FISK, LACEY M (LCSW)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:M
Last Name:FISK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:MAE
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:203 UNITED WAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:FREDERIC
Mailing Address - State:WI
Mailing Address - Zip Code:54837-8938
Mailing Address - Country:US
Mailing Address - Phone:715-327-4322
Mailing Address - Fax:715-327-8509
Practice Address - Street 1:7818 MOLINE RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:WI
Practice Address - Zip Code:54893-8545
Practice Address - Country:US
Practice Address - Phone:715-866-8301
Practice Address - Fax:715-866-8374
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8011-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical