Individual
MS. LACEY LEE NICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCP
Contact information
Practice address
16970 STRAWBERRY DR, ENCINO, CA 91436-3857
(310) 210-0974
Mailing address
16970 STRAWBERRY DR, ENCINO, CA 91436-3857
(310) 210-0974
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
—
—
Other
Enumeration date
03/19/2007
Last updated
07/08/2007
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