Provider Demographics
NPI:1477132777
Name:SMALLDON, LACEY ALISA
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:ALISA
Last Name:SMALLDON
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 1:1818 CALICO CT
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9518
Mailing Address - Country:US
Mailing Address - Phone:614-578-4223
Mailing Address - Fax:
Practice Address - Street 1:1350 W 5TH AVE STE 112
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-2907
Practice Address - Country:US
Practice Address - Phone:614-233-1062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical