Provider Demographics
NPI:1427546167
Name:LUCK, SHANNON (HAS)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:LUCK
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:MCGRATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HAS
Mailing Address - Street 1:778 OLD STATE ROUTE 74
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1213
Mailing Address - Country:US
Mailing Address - Phone:513-474-4300
Mailing Address - Fax:
Practice Address - Street 1:778 OLD STATE ROUTE 74
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1213
Practice Address - Country:US
Practice Address - Phone:513-474-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHIL.03234237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist