Provider Demographics
NPI:1992139661
Name:GALE, LACEY (LICSW)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:GALE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 NICOLLET AVE SOUTH
Mailing Address - Street 2:WASHBURN CENTER FOR CHILDREN
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404
Mailing Address - Country:US
Mailing Address - Phone:612-871-1454
Mailing Address - Fax:612-871-1505
Practice Address - Street 1:2430 NICOLLET AVE SOUTH
Practice Address - Street 2:WASHBURN CENTER FOR CHILDREN
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:612-871-1454
Practice Address - Fax:612-871-1505
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN175331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical