MEDICARE: KATHERINE JAKUCKI MA, LPCC

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	101YM0800X	Mental Health Counselor	1700334	OH
2	101YP2500X	Professional Counselor	E.1901338	OH

General Provider Information

NPI Number	:	1528584927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE JAKUCKI MA, LPCC

Provider Business Mailing Address
First Line	:	1482 PEMBRIDGE DR APT 22
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45255-3135
Country	:	US
Telephone Number	:	609-319-6202
Fax Number	:

Provider Business Practice Location Address
First Line	:	4760 RED BANK RD STE 241
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45227-1548
Country	:	US
Telephone Number	:	513-818-3208
Fax Number	:

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

Provider Enumeration Date	:	08/17/2017
Last Update Date	:	07/05/2023

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