Healthcare Provider Details

I. General information

NPI: 1295640712
Provider Name (Legal Business Name): JESSICA LUCERO SLP-CF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HORIZON DR STE 310
RALEIGH NC
27615-4926
US

IV. Provider business mailing address

110 HORIZON DR STE 310
RALEIGH NC
27615-4926
US

V. Phone/Fax

Practice location:
  • Phone: 888-654-1948
  • Fax: 800-880-4022
Mailing address:
  • Phone: 888-654-1948
  • Fax: 800-880-4022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPSLP.0001615
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: