Provider Demographics
NPI:1518218262
Name:BUKA, JUDY L (MED, LSW)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:L
Last Name:BUKA
Suffix:
Gender:F
Credentials:MED, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10921 REED HARTMAN HIGHWAY
Mailing Address - Street 2:SUITE 104F
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242
Mailing Address - Country:US
Mailing Address - Phone:513-891-1533
Mailing Address - Fax:
Practice Address - Street 1:10921 REED HARTMAN HWY
Practice Address - Street 2:SUITE 104F
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-2830
Practice Address - Country:US
Practice Address - Phone:513-891-1533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0030543171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor