Healthcare Provider Details

I. General information

NPI: 1821901596
Provider Name (Legal Business Name): KARI LUSKY
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 PRAIRIE ST
IDA MI
48140-9778
US

IV. Provider business mailing address

994 WOOD RD
LA SALLE MI
48145-9715
US

V. Phone/Fax

Practice location:
  • Phone: 734-269-9003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101003654
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: