Provider Demographics
NPI:1437933538
Name:PLACE, KACEE JADE (BACHELOR OF SCIENCE)
Entity Type:Individual
Prefix:
First Name:KACEE
Middle Name:JADE
Last Name:PLACE
Suffix:
Gender:F
Credentials:BACHELOR OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 STACY ST
Mailing Address - Street 2:
Mailing Address - City:WISTER
Mailing Address - State:OK
Mailing Address - Zip Code:74966-9566
Mailing Address - Country:US
Mailing Address - Phone:918-413-2658
Mailing Address - Fax:
Practice Address - Street 1:104 STACY ST
Practice Address - Street 2:
Practice Address - City:WISTER
Practice Address - State:OK
Practice Address - Zip Code:74966-9566
Practice Address - Country:US
Practice Address - Phone:918-413-2658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator