Provider Demographics
NPI:1215417514
Name:JONES, LACEY JANE
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:JANE
Last Name:JONES
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:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:OSCODA
Mailing Address - State:MI
Mailing Address - Zip Code:48750-0218
Mailing Address - Country:US
Mailing Address - Phone:989-739-1469
Mailing Address - Fax:
Practice Address - Street 1:5805 CEDAR LAKE RD
Practice Address - Street 2:
Practice Address - City:OSCODA
Practice Address - State:MI
Practice Address - Zip Code:48750-9499
Practice Address - Country:US
Practice Address - Phone:989-739-1469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker