Provider Demographics
NPI:1003110487
Name:HUGHES, MARY LUCILLE (LSLP)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:LUCILLE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:LSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 HEDGEROW DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-4400
Mailing Address - Country:US
Mailing Address - Phone:716-649-5105
Mailing Address - Fax:
Practice Address - Street 1:73 PAWNEE PKWY
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210-1815
Practice Address - Country:US
Practice Address - Phone:716-816-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0082681235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0082681OtherLNEWYORKSTATELICENSENUMBER