Provider Demographics
NPI:1083036198
Name:LUECK, KRISTEN (MT-BC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:LUECK
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13158 15TH ST S
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:MN
Mailing Address - Zip Code:55001-9745
Mailing Address - Country:US
Mailing Address - Phone:651-447-9433
Mailing Address - Fax:
Practice Address - Street 1:13158 15TH ST S
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:MN
Practice Address - Zip Code:55001-9745
Practice Address - Country:US
Practice Address - Phone:651-447-9433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist