Provider Demographics
NPI:1225290661
Name:STUCKE, JEFFREY M (MA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:STUCKE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909A S KENMORE DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-7514
Mailing Address - Country:US
Mailing Address - Phone:812-760-5528
Mailing Address - Fax:
Practice Address - Street 1:909A S KENMORE DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-7514
Practice Address - Country:US
Practice Address - Phone:812-760-5528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001830A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health