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1780875427
LARA JO LACKEY
CLACKAMAS, OR
NPI
1780875427
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: OR L3364)
Enumeration Date
2007-08-07
Last Update Date
2007-08-07
Business Address
-- LARA JO LACKEY M.S.W.
10180 SE SUNNYSIDE RD
CLACKAMAS, OR 97015-8970
Phone number: 503-652-2880
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Mailing Address
-- LARA JO LACKEY M.S.W.
6403 N VILLARD AVE
PORTLAND, OR 97217-4046
Phone number: 503-705-5265
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