Healthcare Provider Details

I. General information

NPI: 1114866555
Provider Name (Legal Business Name): FREIDA LUCKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 LLOYD RD UNIT 383
WICKLIFFE OH
44092-8615
US

IV. Provider business mailing address

PO BOX 383
WICKLIFFE OH
44092-0383
US

V. Phone/Fax

Practice location:
  • Phone: 440-537-8559
  • Fax:
Mailing address:
  • Phone: 440-537-8559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License NumberRP991905
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: