Provider Demographics
NPI:1972841120
Name:TILLOU, LUCY TRICE (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LUCY
Middle Name:TRICE
Last Name:TILLOU
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WALNUT ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2118
Mailing Address - Country:US
Mailing Address - Phone:781-489-3697
Mailing Address - Fax:
Practice Address - Street 1:65 WALNUT ST
Practice Address - Street 2:SUITE 302
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2118
Practice Address - Country:US
Practice Address - Phone:781-489-3697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8770235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist