Provider Demographics
NPI:1992113039
Name:HOLLAND, LACEY LEE (LMT)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:LEE
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7440 SW HUNZIKER ST STE B
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8243
Mailing Address - Country:US
Mailing Address - Phone:503-598-9889
Mailing Address - Fax:
Practice Address - Street 1:7440 SW HUNZIKER ST STE B
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8243
Practice Address - Country:US
Practice Address - Phone:503-598-9889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19764174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist