STACY JEANNE LAACK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****64

License Status

NOT RENEWED

Business

First Name

STACY

Middle

JEANNE

Last Name

LAACK

Business Name

STACY JEANNE LAACK

Original Issue Date

02/26/2001

Effective Date

02/26/2001

Expiration Date

03/01/2006

City

MCHENRY

State

Zip

60050

County

MCHENRY

Ever Disciplined

LastModifiedDate

09/26/2006