Provider Demographics
NPI:1417658527
Name:LUCEY, BRIDGET (MA CF-SLP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:LUCEY
Suffix:
Gender:F
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7650 PETTIBONE RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-4945
Mailing Address - Country:US
Mailing Address - Phone:440-539-3818
Mailing Address - Fax:
Practice Address - Street 1:7537 MENTOR AVE STE 303
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5463
Practice Address - Country:US
Practice Address - Phone:440-252-1909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20221961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty