Provider Demographics
NPI:1174252977
Name:LUCAS, JILL A
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:LUCAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:A
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:823 PARKCENTRE WAY
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-1783
Mailing Address - Country:US
Mailing Address - Phone:208-475-5076
Mailing Address - Fax:
Practice Address - Street 1:823 PARKCENTRE WAY
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1783
Practice Address - Country:US
Practice Address - Phone:208-475-5076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist