MEDICARE: MS. LYNETTE LUCAS SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	146.005678	IL

General Provider Information

NPI Number	:	1720650302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYNETTE LUCAS SLP

Provider Business Mailing Address
First Line	:	2704 5TH ST
Second Line	:
City	:	PERU
State	:	IL
Zip	:	61354-2406
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	999 N STRONG AVE
Second Line	:
City	:	SPRING VALLEY
State	:	IL
Zip	:	61362-1274
Country	:	US
Telephone Number	:	815-664-4601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2021
Last Update Date	:	07/13/2021

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Directions to “ MS. LYNETTE LUCAS SLP” Practice Location

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