Provider Demographics
NPI:1508045147
Name:HOVIK, LACEY N (LMP)
Entity Type:Individual
Prefix:MISS
First Name:LACEY
Middle Name:N
Last Name:HOVIK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 S SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-1712
Mailing Address - Country:US
Mailing Address - Phone:360-421-0812
Mailing Address - Fax:
Practice Address - Street 1:127 S SPRUCE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-1712
Practice Address - Country:US
Practice Address - Phone:360-421-0812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024743174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist