Provider Demographics
NPI:1245589985
Name:BROADY, LUCINDA MELISSA
Entity Type:Individual
Prefix:MRS
First Name:LUCINDA
Middle Name:MELISSA
Last Name:BROADY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LUCINDA
Other - Middle Name:MELISSA
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13862 S BLACKFOOT DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-4568
Mailing Address - Country:US
Mailing Address - Phone:402-618-5808
Mailing Address - Fax:
Practice Address - Street 1:2129 E ARROWHEAD CIR
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-2468
Practice Address - Country:US
Practice Address - Phone:913-839-1868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst