Provider Demographics
NPI:1912712969
Name:FORD, LACEY
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:FORD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:
Other - Last Name:ALLREDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1017 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GREYBULL
Mailing Address - State:WY
Mailing Address - Zip Code:82426-1616
Mailing Address - Country:US
Mailing Address - Phone:307-271-2977
Mailing Address - Fax:
Practice Address - Street 1:1017 N 8TH ST
Practice Address - Street 2:
Practice Address - City:GREYBULL
Practice Address - State:WY
Practice Address - Zip Code:82426-1616
Practice Address - Country:US
Practice Address - Phone:307-271-2977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator