Individual
MISS STACY MARRIE LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1018 LUDINGTON ST, ESCANABA, MI 49829-3541
(702) 277-1369
Mailing address
1600 S 30TH ST TRLR 80, ESCANABA, MI 49829-1073
(702) 277-1369
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501002200
MI
Other
Enumeration date
01/15/2020
Last updated
01/15/2020
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