Provider Demographics
NPI:1912274325
Name:PAULSON, LUCY HART (EDD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:LUCY
Middle Name:HART
Last Name:PAULSON
Suffix:
Gender:F
Credentials:EDD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CAMPUS DRIVE
Mailing Address - Street 2:CSD UM
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59812-6694
Mailing Address - Country:US
Mailing Address - Phone:406-243-2376
Mailing Address - Fax:
Practice Address - Street 1:CSD UM
Practice Address - Street 2:32 CAMPUS DRIVE
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59812-0001
Practice Address - Country:US
Practice Address - Phone:406-243-2376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT385235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist