Provider Demographics
NPI:1710205414
Name:LUCIDO, DANIELLE N (MA, SLP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:N
Last Name:LUCIDO
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4503 BARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-5231
Mailing Address - Country:US
Mailing Address - Phone:330-651-1305
Mailing Address - Fax:
Practice Address - Street 1:6596 ORPHANAGE ROAD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:PA
Practice Address - Zip Code:17247
Practice Address - Country:US
Practice Address - Phone:717-749-3151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009939235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist