Individual
STACY LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
5635 N MARTIN LUTHER KING JR BLVD, TULSA, OK 74126-6409
(918) 594-4731
(918) 595-4269
Mailing address
5635 N MARTIN LUTHER KING JR BLVD, TULSA, OK 74126-6409
(918) 594-4731
(918) 595-4269
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
329
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200065580A
—
OK
Enumeration date
02/15/2007
Last updated
04/02/2015
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