Individual
LACEY JAI BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1616 N GILCREASE MUSEUM RD, TULSA, OK 74127-2101
(210) 627-4013
Mailing address
1616 N GILCREASE MUSEUM RD, TULSA, OK 74127-2101
(210) 627-4013
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
07/16/2015
Last updated
07/16/2015
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