Individual
LACEY J RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
909 S 2ND ST, HIAWATHA, KS 66434-2774
(785) 742-7113
Mailing address
468 2ND ST, BAILEYVILLE, KS 66404-8484
(785) 289-6585
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
9213
KS
Other
Enumeration date
11/09/2011
Last updated
06/10/2014
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