Provider Demographics
NPI:1669449906
Name:WARES, LUCINDA LOUISE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:LOUISE
Last Name:WARES
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 1:5501 N MILITARY TRL APT 106
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-3481
Mailing Address - Country:US
Mailing Address - Phone:716-997-2709
Mailing Address - Fax:
Practice Address - Street 1:5501 N MILITARY TRL APT 106
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-3481
Practice Address - Country:US
Practice Address - Phone:716-997-2709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012189235Z00000X
TX106348235Z00000X
FLSA 10377235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1669449906Medicaid