Provider Demographics
NPI:1851542021
Name:KLAPP, LACIE SHEA (MS)
Entity Type:Individual
Prefix:MISS
First Name:LACIE
Middle Name:SHEA
Last Name:KLAPP
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W EUREKA ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-2968
Mailing Address - Country:US
Mailing Address - Phone:217-552-5697
Mailing Address - Fax:
Practice Address - Street 1:202 E PARK ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3723
Practice Address - Country:US
Practice Address - Phone:217-373-2809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health