Provider Demographics
NPI:1306266010
Name:RZUCIDLO, LYDIA
Entity type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:
Last Name:RZUCIDLO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:STEPHENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:11005 PARKHURST DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-3601
Mailing Address - Country:US
Mailing Address - Phone:216-548-0062
Mailing Address - Fax:
Practice Address - Street 1:11005 PARKHURST DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-3601
Practice Address - Country:US
Practice Address - Phone:216-548-0062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSLP3561235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist