Provider Demographics
NPI:1720832074
Name:SIMONSON, LACY (BIRTH DOULA)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:
Last Name:SIMONSON
Suffix:
Gender:F
Credentials:BIRTH DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 SW ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-5912
Mailing Address - Country:US
Mailing Address - Phone:971-237-1747
Mailing Address - Fax:
Practice Address - Street 1:224 SW ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-5912
Practice Address - Country:US
Practice Address - Phone:971-237-1747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR110918374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty