MEDICARE: MS. SARAH LUECKE

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1780327924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH LUECKE

Provider Business Mailing Address
First Line	:	6650 W STATE ST # D248
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53213-2827
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6650 W STATE ST # D248
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53213-2827
Country	:	US
Telephone Number	:	414-750-5364
Fax Number	:

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

Provider Enumeration Date	:	04/15/2022
Last Update Date	:	04/15/2022

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Directions to “ MS. SARAH LUECKE ” Practice Location

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