1366721193 NPI number — MRS. LUCINDA LEE DIGGS M.S., CCC-SLP

Table of content: REALITE LANICE PEEBLES LBA, BCBA (NPI 1255985008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366721193 NPI number — MRS. LUCINDA LEE DIGGS M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIGGS
Provider First Name:
LUCINDA
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366721193
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2804 DEL PRADO BLVD S
Provider Second Line Business Mailing Address:
SUITE 202-3
Provider Business Mailing Address City Name:
CAPE CORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33904-7252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-540-1179
Provider Business Mailing Address Fax Number:
239-540-8563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2804 DEL PRADO BLVD S
Provider Second Line Business Practice Location Address:
SUITE 202-3
Provider Business Practice Location Address City Name:
CAPE CORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33904-7252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-540-1179
Provider Business Practice Location Address Fax Number:
239-540-8563
Provider Enumeration Date:
08/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SA6543 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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