Individual
JACOB LACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
1815 STEWART AVE, WAUSAU, WI 54401-5373
(715) 849-8703
Mailing address
1815 STEWART AVE, WAUSAU, WI 54401-5373
(715) 849-8703
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
—
WI
Other
Enumeration date
07/31/2024
Last updated
07/31/2024
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