Individual
LARA JO LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.W.
Contact information
Practice address
10180 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
(503) 652-2880
Mailing address
6403 N VILLARD AVE, PORTLAND, OR 97217-4046
(503) 705-5265
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L3364
OR
Other
Enumeration date
08/07/2007
Last updated
08/07/2007
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