Provider Demographics
NPI:1346639374
Name:LUMAS, SIYAN (ED S)
Entity Type:Individual
Prefix:
First Name:SIYAN
Middle Name:
Last Name:LUMAS
Suffix:
Gender:F
Credentials:ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 SWEETWATER LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-4314
Mailing Address - Country:US
Mailing Address - Phone:618-540-8574
Mailing Address - Fax:
Practice Address - Street 1:327 SWEETWATER LN
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-4314
Practice Address - Country:US
Practice Address - Phone:618-540-8574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist