Provider Demographics
NPI:1467011106
Name:DYCUS, LANA SUZETTE
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:SUZETTE
Last Name:DYCUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 GILHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-5720
Mailing Address - Country:US
Mailing Address - Phone:270-564-0949
Mailing Address - Fax:
Practice Address - Street 1:220 GILHAVEN DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-5720
Practice Address - Country:US
Practice Address - Phone:270-564-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist