Provider Demographics
NPI:1184942617
Name:LACKEY, LISA M
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:LACKEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5772 PEARTON CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-2700
Mailing Address - Country:US
Mailing Address - Phone:513-289-7285
Mailing Address - Fax:
Practice Address - Street 1:7055 ENGLE RD BLDG 6-601
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-8491
Practice Address - Country:US
Practice Address - Phone:216-200-7840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator