Provider Demographics
NPI:1053712216
Name:LUCAS, SELENA
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:SALT ROCK
Mailing Address - State:WV
Mailing Address - Zip Code:25559-9712
Mailing Address - Country:US
Mailing Address - Phone:304-360-6000
Mailing Address - Fax:
Practice Address - Street 1:10 MARLAND AVE
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:WV
Practice Address - Zip Code:25523-1058
Practice Address - Country:US
Practice Address - Phone:304-824-3033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist