Malea Grace Lack

NPI #1144919283 in Kennett, Missouri

Provider Information

NPI Number: 1144919283
Entity Type: Individual
Name: Malea Grace Lack
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: May 4, 2023
Last Updated: May 4, 2023

Practice Location

Address: 1226 INDEPENDENCE AVE
City: Kennett
State: Missouri
ZIP Code: 63857-1316
Phone: (573) 559-2380

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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