Search › Illinois › 163W00000X
Jadeyn Lacey
NPI 1447949714 · on the registry since 2023
Practice
- Address
- 1336 E Empire St
Bloomington, IL 61701 - Phone
- (309) 863-5454
Additional practice sites
- 2412 E Washington St Ste 4a, Bloomington, IL
Registry record
- Primary taxonomy
- 163W00000X
163W00000X
- Also registered as
- 163WC0200X
163WE0003X - Licence states on file
- IL
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2023-05-03
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois