Provider Demographics
NPI:1093355307
Name:MIDDAUGH, LUCINDA CLAY (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:CLAY
Last Name:MIDDAUGH
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PRATER DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8663
Mailing Address - Country:US
Mailing Address - Phone:859-576-5234
Mailing Address - Fax:
Practice Address - Street 1:105 PRATER DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8663
Practice Address - Country:US
Practice Address - Phone:859-576-5234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY142344235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNONE