Provider Demographics
NPI:1518668342
Name:GILLASPY, LACIE DEA
Entity Type:Individual
Prefix:
First Name:LACIE
Middle Name:DEA
Last Name:GILLASPY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LACIE
Other - Middle Name:DEA
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1392
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68702-1392
Mailing Address - Country:US
Mailing Address - Phone:402-371-0220
Mailing Address - Fax:
Practice Address - Street 1:1203 S 8TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5875
Practice Address - Country:US
Practice Address - Phone:402-371-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator