Healthcare Provider Details

I. General information

NPI: 1194646547
Provider Name (Legal Business Name): JOANNA KALUCKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 SMITH RD
CHESTERFIELD MA
01012
US

IV. Provider business mailing address

8 JEANNE CIR
SOUTHAMPTON MA
01073-9470
US

V. Phone/Fax

Practice location:
  • Phone: 413-296-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP96026
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: