Basic Information
Provider Information
NPI: 1174045041
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCOTT
FirstName: LASHONDA
MiddleName: LUCAS
NamePrefix:  
NameSuffix:  
Credential: MS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: LUCAS
OtherFirstName: LASHONDA
OtherMiddleName: DARCEL
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: MS
OtherLastNameType: 1
Mailing Information
Address1: 1200 FIRST STREET N.E.
Address2: 9TH FLOOR
City: WASHINGTON
State: DC
PostalCode: 20002
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1200 1ST ST NE FL E9
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200023361
CountryCode: US
TelephoneNumber: 2024425026
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/12/2017
LastUpdateDate: 07/12/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X  Y Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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