Provider Demographics
NPI:1245991678
Name:HACKMAN, LAURI MARIE SPENCER (MA)
Entity type:Individual
Prefix:
First Name:LAURI
Middle Name:MARIE SPENCER
Last Name:HACKMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:FT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2854
Mailing Address - Country:US
Mailing Address - Phone:859-445-1672
Mailing Address - Fax:
Practice Address - Street 1:12 OXFORD DR
Practice Address - Street 2:
Practice Address - City:FT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-2854
Practice Address - Country:US
Practice Address - Phone:859-445-1672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator