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Individual

JUDY M LANSING

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CACIII

Contact information

Practice address
296 MOUACHE DR., IGNACIO, CO 81137-0429
(970) 563-4555
(970) 563-4618
Mailing address
296 MOUACHE DR., IGNACIO, CO 81137-0429
(970) 563-4555
(970) 563-4618

Taxonomy

Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
116600
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1390
CACIII
CO
Enumeration date
05/06/2009
Last updated
05/06/2009
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