Individual
COURTNEY N LACZKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3535 PENTAGON BLVD, BEAVERCREEK, OH 45431-1705
(937) 702-4503
(937) 702-4129
Mailing address
3588 SEQUOIA DR, BEAVERCREEK, OH 45431-3779
(518) 956-0372
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA059099
PA
Other
Enumeration date
05/01/2017
Last updated
07/25/2024
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