Provider Demographics
NPI:1093013104
Name:LUCAS, JENNIFER (SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 MARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:PA
Mailing Address - Zip Code:16023-2206
Mailing Address - Country:US
Mailing Address - Phone:724-352-1571
Mailing Address - Fax:724-352-4685
Practice Address - Street 1:134 MARWOOD RD
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:PA
Practice Address - Zip Code:16023-2206
Practice Address - Country:US
Practice Address - Phone:724-352-1571
Practice Address - Fax:724-352-4685
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005797L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist