MEDICARE: CHRISTINE LUKETIC M.A., CCC-SLP

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	235Z00000X	Speech-Language Pathologist	10653	OH

General Provider Information

NPI Number	:	1255105946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE LUKETIC M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	18190 ROLLING BROOK DR
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44023-4859
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3185 W 41ST ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-1275
Country	:	US
Telephone Number	:	216-263-7008
Fax Number	:

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

Provider Enumeration Date	:	11/13/2023
Last Update Date	:	11/13/2023

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Directions to “ CHRISTINE LUKETIC M.A., CCC-SLP” Practice Location

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