Provider Demographics
NPI:1124194899
Name:LUCAS, REAGAN F (MSCCC SLP)
Entity Type:Individual
Prefix:
First Name:REAGAN
Middle Name:F
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MSCCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 OLD HARSHMAN RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:OH
Mailing Address - Zip Code:45431-1238
Mailing Address - Country:US
Mailing Address - Phone:937-237-4270
Mailing Address - Fax:
Practice Address - Street 1:801 OLD HARSHMAN RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:OH
Practice Address - Zip Code:45431-1238
Practice Address - Country:US
Practice Address - Phone:937-237-4270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 8378235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist