Provider Demographics
NPI:1558620955
Name:LUCCHESI, DAPHNE RENE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:RENE
Last Name:LUCCHESI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 GREENWOOD PLAZA BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4816
Mailing Address - Country:US
Mailing Address - Phone:972-768-7860
Mailing Address - Fax:
Practice Address - Street 1:6000 GREENWOOD PLAZA BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4816
Practice Address - Country:US
Practice Address - Phone:972-768-7860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103002235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47032359Medicaid
TX149984001Medicaid
TX207164901Medicaid
TX676535Medicare PIN
CO47032359Medicaid