Individual
LACEY RUSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
110 WEST BROADWAY, SUITE 202, WILLISTON, ND 58801
(701) 774-6300
(701) 572-9794
Mailing address
110 WEST BROADWAY, SUITE 202, WILLISTON, ND 58801
(701) 774-6300
(701) 572-9794
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
4689
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
50763
—
ND
Enumeration date
04/24/2014
Last updated
04/16/2025
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