Individual
LAURIE N TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
240 N TILLOTSON AVE, MUNCIE, IN 47304-3988
(765) 288-1928
Mailing address
240 N TILLOTSON AVE, MUNCIE, IN 47304-3988
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/20/2020
Last updated
09/13/2022
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