Provider Demographics
NPI:1407971526
Name:COFFEE, KACI LEE (LAC)
Entity Type:Individual
Prefix:MS
First Name:KACI
Middle Name:LEE
Last Name:COFFEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 E HAMPDEN AVE
Mailing Address - Street 2:APT. 3429
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-7678
Mailing Address - Country:US
Mailing Address - Phone:818-800-1604
Mailing Address - Fax:
Practice Address - Street 1:6300 E HAMPDEN AVE
Practice Address - Street 2:APT. 3429
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-7678
Practice Address - Country:US
Practice Address - Phone:818-800-1604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA11579171100000X
CO1491171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist