Provider Demographics
NPI:1740841436
Name:KEENEY, LACEY NICOLE (LE)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:NICOLE
Last Name:KEENEY
Suffix:
Gender:F
Credentials:LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 GOODPASTURE LOOP APT H133
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-1426
Mailing Address - Country:US
Mailing Address - Phone:541-221-5175
Mailing Address - Fax:541-221-5175
Practice Address - Street 1:1623 OAK ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4022
Practice Address - Country:US
Practice Address - Phone:541-221-5175
Practice Address - Fax:541-221-5175
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORBAP-E-10199530174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty