Individual
LACEY ANN SKELTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LEVEL 1 MED AIDE
Contact information
Practice address
18941 CR 305A, EMINENCE, MO 65466-6268
(573) 226-5426
(573) 226-5426
Mailing address
18941 CR 305A, EMINENCE, MO 65466-6268
(573) 226-5426
(573) 226-5426
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
049124
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
84-1730316
—
MO
Enumeration date
08/19/2021
Last updated
10/05/2021
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