Provider Demographics
NPI:1952425415
Name:LUCAS, MATTHEW F (AUD, MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:F
Last Name:LUCAS
Suffix:
Gender:M
Credentials:AUD, MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 BECK RD STE C307
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3685
Mailing Address - Country:US
Mailing Address - Phone:816-233-0007
Mailing Address - Fax:816-232-5056
Practice Address - Street 1:3715 BECK RD STE C307
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3685
Practice Address - Country:US
Practice Address - Phone:816-233-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108364231H00000X
NE175231H00000X
MO1047237700000X
NE644237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist