Provider Demographics
NPI:1619543774
Name:COLE, LUCAS (MSED)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:COLE
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 STATE STREET
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1041
Mailing Address - Country:US
Mailing Address - Phone:585-343-2480
Mailing Address - Fax:
Practice Address - Street 1:260 STATE STREET
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1041
Practice Address - Country:US
Practice Address - Phone:585-343-2480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-31
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist