Individual
LACEY MARIE LONGWITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
300 OCEAN AVE, RAYMOND, WA 98577-3016
(360) 942-2303
Mailing address
300 OCEAN AVE, RAYMOND, WA 98577-3016
(360) 942-2303
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
04/19/2017
Last updated
01/29/2020
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