Provider Demographics
NPI:1255162830
Name:LUCAS, ERIN (SLP-CCC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 PORTOFINO DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-8745
Mailing Address - Country:US
Mailing Address - Phone:209-480-2017
Mailing Address - Fax:
Practice Address - Street 1:2504 PORTOFINO DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-8745
Practice Address - Country:US
Practice Address - Phone:209-480-2017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35337235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist