Provider Demographics
NPI:1952143364
Name:LUCAS, MYCHAELLAH MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:MYCHAELLAH
Middle Name:MARIE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MAHANOY CITY
Mailing Address - State:PA
Mailing Address - Zip Code:17948-2924
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1039 E MARKET ST
Practice Address - Street 2:
Practice Address - City:MAHANOY CITY
Practice Address - State:PA
Practice Address - Zip Code:17948-2924
Practice Address - Country:US
Practice Address - Phone:570-778-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL017773235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist