Provider Demographics
NPI:1184806119
Name:ALLSTOT, LACI N
Entity type:Individual
Prefix:MRS
First Name:LACI
Middle Name:N
Last Name:ALLSTOT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LACI
Other - Middle Name:N
Other - Last Name:WARDLAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6629 HIDDEN CREEK LOOP NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-7879
Mailing Address - Country:US
Mailing Address - Phone:503-930-6175
Mailing Address - Fax:
Practice Address - Street 1:1073 OAK ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4018
Practice Address - Country:US
Practice Address - Phone:503-585-4949
Practice Address - Fax:503-585-4965
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator