Individual
LUCAS NORTHERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SLP
Contact information
Practice address
30 BUXTON FARM RD STE 230, STAMFORD, CT 06905-1206
(203) 212-4191
Mailing address
30 BUXTON FARM RD STE 230, STAMFORD, CT 06905-1206
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
006772
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006772
SLP
CT
Enumeration date
08/08/2022
Last updated
08/08/2022
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