Individual
VIVIAN LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2 NW 2ND AVE, PORTLAND, OR 97209-3902
(503) 226-7387
Mailing address
2 NW 2ND AVE, PORTLAND, OR 97209-3902
(503) 226-7387
(503) 226-7921
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/04/2014
Last updated
11/04/2014
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