Provider Demographics
NPI:1588121040
Name:LUCAS, ERINN MICHELLE (M ED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ERINN
Middle Name:MICHELLE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:M ED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WESLEYAN DR APT 1314
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-8820
Mailing Address - Country:US
Mailing Address - Phone:478-308-0079
Mailing Address - Fax:
Practice Address - Street 1:117 3RD ST E
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4879
Practice Address - Country:US
Practice Address - Phone:229-402-7188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009789235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist