Provider Demographics
NPI:1104449750
Name:LUCAS, LISA M (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 CRITTWOODS CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-3809
Mailing Address - Country:US
Mailing Address - Phone:513-235-8511
Mailing Address - Fax:
Practice Address - Street 1:2813 CRITTWOODS CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244-3809
Practice Address - Country:US
Practice Address - Phone:513-235-8511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP20341235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist