Healthcare Provider Details

I. General information

NPI: 1669449906
Provider Name (Legal Business Name): LUCINDA LOUISE WARES MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 N MILITARY TRL APT 106
BOCA RATON FL
33496-3481
US

IV. Provider business mailing address

5501 N MILITARY TRL APT 106
BOCA RATON FL
33496-3481
US

V. Phone/Fax

Practice location:
  • Phone: 716-997-2709
  • Fax:
Mailing address:
  • Phone: 716-997-2709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number012189
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number106348
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 10377
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: