Provider Demographics
NPI:1295160117
Name:LACKO, DAWN
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:
Last Name:LACKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5080 YESNESS LN
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-5204
Mailing Address - Country:US
Mailing Address - Phone:307-259-5134
Mailing Address - Fax:307-237-5222
Practice Address - Street 1:5080 YESNESS LN
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-5204
Practice Address - Country:US
Practice Address - Phone:307-259-5134
Practice Address - Fax:307-237-5222
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator