Provider Demographics
NPI:1407885643
Name:REARDON, LUCIA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:
Last Name:REARDON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 BLANCHARD RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04021-3209
Mailing Address - Country:US
Mailing Address - Phone:207-829-4656
Mailing Address - Fax:
Practice Address - Street 1:314 BLANCHARD RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:ME
Practice Address - Zip Code:04021-3209
Practice Address - Country:US
Practice Address - Phone:207-829-4656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1070235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME042865OtherANTHEM INSURANCE