MEDICARE: MRS. KIMBERLY SUE LUCKRING MA CCC/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	SP-5323	OH

General Provider Information

NPI Number	:	1548689706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY SUE LUCKRING MA CCC/SLP

Provider Business Mailing Address
First Line	:	2735 DUANE AVE NW
Second Line	:
City	:	MASSILLON
State	:	OH
Zip	:	44647
Country	:	US
Telephone Number	:	330-904-4972
Fax Number	:

Provider Business Practice Location Address
First Line	:	3057 CLEVELAND AVE SW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44707-3625
Country	:	US
Telephone Number	:	330-484-2547
Fax Number	:

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

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	04/15/2014

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Directions to “ MRS. KIMBERLY SUE LUCKRING MA CCC/SLP” Practice Location

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