Provider Demographics
NPI:1255842480
Name:LUCIDO, ELLIE PATRICIA (CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELLIE
Middle Name:PATRICIA
Last Name:LUCIDO
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:ELLIE
Other - Middle Name:PATRICIA
Other - Last Name:WESTEMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6221 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57107-7064
Mailing Address - Country:US
Mailing Address - Phone:605-367-4440
Mailing Address - Fax:
Practice Address - Street 1:6221 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57107-7064
Practice Address - Country:US
Practice Address - Phone:605-367-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD750-PROV235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist