Provider Demographics
NPI:1811369218
Name:STICKLE, LACY
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:
Last Name:STICKLE
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 1:580 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-9910
Mailing Address - Country:US
Mailing Address - Phone:330-376-9494
Mailing Address - Fax:330-376-4525
Practice Address - Street 1:580 GRANT ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-9910
Practice Address - Country:US
Practice Address - Phone:330-376-9494
Practice Address - Fax:330-376-4525
Is Sole Proprietor?:No
Enumeration Date:2015-10-24
Last Update Date:2016-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information