Provider Demographics
NPI:1396091021
Name:LUCAS, LISA K
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:LUCAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MARTIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2628
Mailing Address - Country:US
Mailing Address - Phone:856-665-7800
Mailing Address - Fax:
Practice Address - Street 1:101 E MORELAND RD
Practice Address - Street 2:STE A
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-4109
Practice Address - Country:US
Practice Address - Phone:215-784-9987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03497237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist