MEDICARE: KATHY LYNN LUKEY LISW-S, LCSW

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
1	1041C0700X	Clinical Social Worker	I.0009199	OH
2	1041C0700X	Clinical Social Worker	KY.1361	KY

General Provider Information

NPI Number	:	1245540707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY LYNN LUKEY LISW-S, LCSW

Provider Business Mailing Address
First Line	:	127 GRANT PARK DR
Second Line	:
City	:	DAYTON
State	:	KY
Zip	:	41074-1745
Country	:	US
Telephone Number	:	859-462-0371
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 DIXIE HWY
Second Line	:
City	:	FT WRIGHT
State	:	KY
Zip	:	41011-2766
Country	:	US
Telephone Number	:	859-341-7453
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2010
Last Update Date	:	04/03/2023

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