| Robert Lack | |
|
4911 W Canal Dr Kennewick WA 99336-7755 | |
| (509) 735-7410 | |
| (509) 783-5953 |
| Full Name | Robert Lack |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4911 W Canal Dr, Kennewick, Washington |
| Authorized Official Name and Position | Robert Glenn Lack (ADMINISTRATOR) |
| Authorized Official Contact | 5097357410 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert Lack Po Box 5697 Kennewick WA 99336-0697 Ph: (509) 735-7410 | Robert Lack 4911 W Canal Dr Kennewick WA 99336-7755 Ph: (509) 735-7410 |
| NPI Number | 1205241106 |
|---|---|
| Provider Enumeration Date | 06/30/2014 |
| Last Update Date | 06/30/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205241106 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 03060500 (Washington) | Primary |
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