Individual
MR. RUSSELL JOSEPH LACELLE II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LVT, CORPORAL
Contact information
Practice address
19649 JOLGREN DR, CLINTON TOWNSHIP, MI 48038-2259
(586) 909-9875
Mailing address
19649 JOLGREN DR, CLINTON TOWNSHIP, MI 48038-2259
(586) 909-9875
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/31/2023
Last updated
07/31/2023
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