Provider Demographics
NPI:1689380875
Name:LUCAS, DANIELLE (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:SCHROEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9650 STATE ROUTE 613
Mailing Address - Street 2:
Mailing Address - City:LEIPSIC
Mailing Address - State:OH
Mailing Address - Zip Code:45856-9417
Mailing Address - Country:US
Mailing Address - Phone:419-969-4386
Mailing Address - Fax:
Practice Address - Street 1:28046 WATSON RD
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-8851
Practice Address - Country:US
Practice Address - Phone:419-395-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.11900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP.11900OtherOHIO SLP
14089193OtherASHA