Provider Demographics
NPI:1134286180
Name:GROSS BEDGOOD, LUCINDA (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LUCINDA
Middle Name:
Last Name:GROSS BEDGOOD
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:MRS
Other - First Name:LUCINDA
Other - Middle Name:
Other - Last Name:GROSS-BARLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:69 LINDSEY LANE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ST. MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-1702
Mailing Address - Country:US
Mailing Address - Phone:912-729-2294
Mailing Address - Fax:912-673-9457
Practice Address - Street 1:69 LINDSEY LANE
Practice Address - Street 2:SUITE A
Practice Address - City:ST. MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-1702
Practice Address - Country:US
Practice Address - Phone:912-729-2294
Practice Address - Fax:912-673-9457
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001226235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10059138OtherAMERIGROUP PROVIDER NUMBE
GA000584438EMedicaid
GA343639OtherWELLCARE PROVIDER NUMBER