Provider Demographics
NPI:1326059775
Name:LOUCKA, PATRICIA A (PHD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:LOUCKA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OBERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44074-1600
Mailing Address - Country:US
Mailing Address - Phone:440-774-5477
Mailing Address - Fax:
Practice Address - Street 1:5 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1600
Practice Address - Country:US
Practice Address - Phone:440-774-5477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4427103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LOCP10121Medicare ID - Type Unspecified