LACEY JACKSON (NPI# 1417096082) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417096082 |
| Entity Type | Individual |
| Full Name | LACEY JACKSON |
| Credential | LMP |
| Practice Address |
712 Trosper Rd Sw Tumwater WA 98512-6934 |
| Mailing Address |
Po Box 14654 Tumwater WA 98511-4654 |
| Practice Telephone | 3605702273 |
| Mailing Telephone | 3605702273 |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | MA00013081 | WA | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669031514 | Lacey Jackson | Behavior Technician | 124 Lisa Ave, Lathrop, MO 64465-9641 | 2019-06-12 |
| 1639794746 | Lacey Kristine Jackson | Behavioral Analyst | 1537 E Grande Blvd, Tyler, TX 75703-3900 | 2020-06-15 |
| 1013542497 | Lacey Janee Jackson | Specialist/Technologist, Other | 1141 N Loop 1604 E # 105-610, San Antonio, TX 78232-1339 | 2020-03-06 |
| 1942762497 | Lacey Jackson | Counselor | 1101 E Monroe Ave, Mcalester, OK 74501-4815 | 2019-04-03 |
| 1780976530 | Lacey Jean Jackson | Pharmacist | 4220 Wheaton Way, Bremerton, WA 98310-3604 | 2011-05-12 |
| 1790098317 | Lacey J Jackson | Pharmacist | 11815 Fountain Way, One City Center Suite 300, Newport News, VA 23606-4448 | 2010-07-24 |
| Street Address |
712 TROSPER RD SW |
| City | TUMWATER |
| State | WA |
| Zip Code | 98512-6934 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891752150 | Gayle Lindsey Burditt | Speech-Language Pathologist | 712 Trosper Rd Sw, Tumwater, WA 98512-6934 | 2006-04-28 |
| 1952476699 | Fredrick Lewis Sickelbower | Massage Therapist | 712 Trosper Rd Sw, Tumwater, WA 98512-6934 | 2006-11-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578161402 | Yavonnie Leslie Griggs | Peer Specialist | 3285 Ferguson Ln Sw, Tumwater, Wa 98512, Tumwater, WA 98512 | 2020-10-13 |
| 1205465622 | Falina Marie Luce | Counselor | 3285 Ferguson St, Olympia, WA 98512 | 2020-04-07 |
| 1881234912 | Andres Enrique Velazquez | Counselor | 3285 Ferguson St Sw Wa 98512, Tumwater, WA 98512 | 2020-01-07 |
| 1700432507 | Maria E Zavala Negrete | Behavior Technician | 3285 Ferguson Street Southwest, Tumwater, WA 98512 | 2019-08-16 |
| 1669026951 | Bradley Allen Labrador | Social Worker | 3285 Ferguson St, Sw, Tumwater, WA 98512 | 2019-07-25 |
| 1033762893 | Janice Lapreal Swanzey | Licensed Practical Nurse | 3285 Ferguson Lane St Sw, Olympia, WA 98512 | 2019-07-22 |
| 1821569195 | Linda Marie Moffitt | Registered Nurse | 7741 Littlerock Rd. Sw, Tumwater, WA 98512 | 2018-12-16 |
| 1427534577 | Matthew Hart | Occupational Therapist | 2620 Rw Johnson Boulevard Southwest Suite 112, Tumwater, WA 98512 | 2018-07-12 |
| 1558858019 | Amy Louise Cline | Counselor | 6005 Tyee Drive Sw, Tumwater, WA 98512 | 2018-04-19 |
| 1669998183 | Bradley Ross Bishop | Registered Nurse | 3285 Ferguson Street Sw, Tumwater, WA 98512 | 2017-08-16 |
| Find all providers in zip 98512 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033453147 | Amy M Sistrunk | Specialist | 3300 21st Ave Sw Apt L3, Tumwater, WA 98512-5688 | 2012-11-15 |
| 1235431958 | Ashleigh Aldrich | Specialist | 3185 Vista Verde Ln Sw, Tumwater, WA 98512-1448 | 2010-12-01 |
| 1518269422 | Christina Nicole King | Specialist | 3701 Hoadly Loop Se, Tumwater, WA 98501-4143 | 2010-11-29 |
| 1427370634 | Aniysa Carlin Zuchowski | Specialist | 344 Cleveland Ave Se Ste B, Tumwater, WA 98501 | 2010-02-16 |
| 1083946768 | Alicia Leandra Gonzales | Specialist | 5450 Cuda Ln Unit 102, Tumwater, WA 98512-6942 | 2010-02-05 |
| 1245561190 | Cynthia Carol Foster | Specialist | 204pinehurst Dr.sw., Tumwater, WA 98501-4500 | 2010-01-15 |
| 1972836575 | Teresa K Mosby | Specialist | 6200 Capitol Blvd Se, Ste C, Tumwater, WA 98501-5288 | 2009-09-14 |
| 1215260336 | Jessika Renee Everson | Specialist | 7927 Littlerock Rd Sw, Tumwater, WA 98512-7429 | 2009-09-08 |
| 1699980722 | Rita Altamore | Specialist | 101 Israel Rd Se, Tumwater, WA 98501-5570 | 2007-05-11 |
| 1154536225 | Lorelei Randall | Specialist | 100 Ruby St Se Ste F, Tumwater, WA 98501-6724 | 2007-05-11 |
| Find all providers in TUMWATER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.