Individual
MRS. TERRA DOVE LASECKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DEVELOPMENTAL THERAP
Contact information
Practice address
1305 CUMBERLAND AVE STE 225, WEST LAFAYETTE, IN 47906-1343
(812) 841-7130
Mailing address
1305 CUMBERLAND AVE STE 225, WEST LAFAYETTE, IN 47906-1343
(812) 841-7130
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
222Q00000X
Developmental Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200732240
DEVELOPMENTAL THERAPIST
IN
05
—
200732240
—
IN
Enumeration date
04/05/2007
Last updated
07/18/2022
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