Provider Demographics
NPI:1225160294
Name:LUCAS-CROWDER, VICKI LEVON
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:LEVON
Last Name:LUCAS-CROWDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5321 PASSENGER PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-8223
Mailing Address - Country:US
Mailing Address - Phone:919-661-8707
Mailing Address - Fax:919-329-0355
Practice Address - Street 1:5321 PASSENGER PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-8223
Practice Address - Country:US
Practice Address - Phone:919-661-8707
Practice Address - Fax:919-329-0355
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3902235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7401075Medicaid