Provider Demographics
NPI:1205349842
Name:LUCAS, SANDRA CHARLOTTE (MA CFY-SLP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:CHARLOTTE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MA CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2636
Mailing Address - Country:US
Mailing Address - Phone:509-573-7000
Mailing Address - Fax:
Practice Address - Street 1:1114 W PIERCE ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-5823
Practice Address - Country:US
Practice Address - Phone:509-573-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA543749F235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist