Provider Demographics
NPI:1619390150
Name:HEIN, LACEY BRIEANNE (LSW)
Entity Type:Individual
Prefix:MISS
First Name:LACEY
Middle Name:BRIEANNE
Last Name:HEIN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 22ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-1071
Mailing Address - Country:US
Mailing Address - Phone:701-857-0729
Mailing Address - Fax:701-857-0791
Practice Address - Street 1:400 22ND AVE NW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-1071
Practice Address - Country:US
Practice Address - Phone:701-857-0729
Practice Address - Fax:701-857-0791
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4699104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker