Provider Demographics
NPI:1720228281
Name:KATZ LACKEY, DEBORAH SUE (RN)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:SUE
Last Name:KATZ LACKEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 OLD MULDOON RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4039
Mailing Address - Country:US
Mailing Address - Phone:907-770-1899
Mailing Address - Fax:
Practice Address - Street 1:3360 OLD MULDOON RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4039
Practice Address - Country:US
Practice Address - Phone:907-770-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK19912101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor