MEDICARE: MRS. LAINE LUCKENBACH M.S. 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	SP00950	RI

General Provider Information

NPI Number	:	1285815498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAINE LUCKENBACH M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	2 TERN DR
Second Line	:
City	:	WAKEFIELD
State	:	RI
Zip	:	02879-6106
Country	:	US
Telephone Number	:	401-226-7051
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 SAINT ELIZABETH WAY
Second Line	:
City	:	EAST GREENWICH
State	:	RI
Zip	:	02818-2163
Country	:	US
Telephone Number	:	401-886-6600
Fax Number	:

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

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	02/24/2026

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Directions to “ MRS. LAINE LUCKENBACH M.S. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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