Healthcare Provider Details

I. General information

NPI: 1003740432
Provider Name (Legal Business Name): MEEGAN MASSIE LUCORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 S 3RD AVE
OAKDALE CA
95361-3935
US

IV. Provider business mailing address

10705 OAK VALLEY RD
ANGELS CAMP CA
95222-9627
US

V. Phone/Fax

Practice location:
  • Phone: 209-848-4884
  • Fax:
Mailing address:
  • Phone: 209-848-4884
  • Fax: 209-847-0155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP11074
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: