Provider Demographics
NPI:1003023532
Name:LAUCK, JEAN M
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:M
Last Name:LAUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 GILLIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45233-4303
Mailing Address - Country:US
Mailing Address - Phone:513-941-4151
Mailing Address - Fax:
Practice Address - Street 1:2950 GILLIGAN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45233-4303
Practice Address - Country:US
Practice Address - Phone:513-941-4151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2705915Medicaid