Provider Demographics
NPI:1043461049
Name:WESTON, LUCINDA D (MS CCC)
Entity Type:Individual
Prefix:MS
First Name:LUCINDA
Middle Name:D
Last Name:WESTON
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 N MURRAY AVE
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2555
Mailing Address - Country:US
Mailing Address - Phone:414-332-3537
Mailing Address - Fax:414-332-8096
Practice Address - Street 1:3828 N MURRAY AVE
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2555
Practice Address - Country:US
Practice Address - Phone:414-332-3537
Practice Address - Fax:414-332-8096
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI615-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42681500Medicaid