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NPI Code Detail

MEDICARE: HEATHER LUEDTKE

MEDICARE: HEATHER LUEDTKE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerI.1200699OH

General Provider Information

NPI Number : 1114311693
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER LUEDTKE
Provider Business Mailing Address
First Line : 2651 OBSERVATORY AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45208-2040
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2651 OBSERVATORY AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45208-2040
Country : US
Telephone Number : 513-310-8408
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2015
Last Update Date : 03/24/2015

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Directions to “ HEATHER LUEDTKE ” Practice Location

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