Individual
LACEY SIMMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
302 CHERRY LN STE 101, MANTECA, CA 95337-4311
(209) 647-6296
Mailing address
302 CHERRY LN STE 101, MANTECA, CA 95337-4311
(209) 647-6296
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
10/04/2023
Last updated
03/12/2024
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