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General NPI Number Information
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NPI Number | 1205008505
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Entity Type | Individual
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Provider Name | ROBERTA KAYE LUCKEL
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Gender | Female
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 05/04/2023
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Provider Practice Location Address
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Address Line | 601 HIGHWAY 6 W
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City | IOWA CITY
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State | IA
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Zip | 52246-2209
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Country | US
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Telephone | 319-351-1110
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Fax | 319-383-2625
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Provider Business Mailing Address
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Address Line | 3784 COTTAGE RESERVE RD NE
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City | SOLON
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State | IA
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Zip | 52333-9225
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Country | US
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Telephone | 319-331-1532
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 02624
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License Number State | IA
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