Provider Demographics
NPI:1063835114
Name:LUKETIC, JAMIE EILEEN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:EILEEN
Last Name:LUKETIC
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:44232-0667
Mailing Address - Country:US
Mailing Address - Phone:330-896-9119
Mailing Address - Fax:330-896-1185
Practice Address - Street 1:88 CHELMSFORD DR.
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-4420
Practice Address - Country:US
Practice Address - Phone:513-255-6164
Practice Address - Fax:330-896-1185
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHSP9039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist