Healthcare Provider Details

I. General information

NPI: 1831002559
Provider Name (Legal Business Name): JACQUELINE LUEA MS CCC-SLP
Entity Type: Individual
Gender: Female
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

6570 BRUSH ST
NORTH BRANCH MI
48461-8842
US

IV. Provider business mailing address

1676 WILD CHERRY LN
LAPEER MI
48446-8714
US

V. Phone/Fax

Practice location:
  • Phone: 810-688-3284
  • Fax:
Mailing address:
  • Phone: 810-688-3284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101004359
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: