Provider Demographics
NPI:1760559561
Name:LUCAS, ANDRAE C (MS CCCA)
Entity Type:Individual
Prefix:MRS
First Name:ANDRAE
Middle Name:C
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MS CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 N GREENWOOD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2657
Mailing Address - Country:US
Mailing Address - Phone:719-544-7115
Mailing Address - Fax:715-544-6242
Practice Address - Street 1:1619 N GREENWOOD
Practice Address - Street 2:SUITE 309
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2657
Practice Address - Country:US
Practice Address - Phone:719-544-7115
Practice Address - Fax:715-544-6242
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO99073773Medicaid