Provider Demographics
NPI:1528584927
Name:JAKUCKI, KATHERINE (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:JAKUCKI
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1482 PEMBRIDGE DR APT 22
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-3135
Mailing Address - Country:US
Mailing Address - Phone:609-319-6202
Mailing Address - Fax:
Practice Address - Street 1:4760 RED BANK RD STE 241
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-1548
Practice Address - Country:US
Practice Address - Phone:513-818-3208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1700334101YM0800X
OHE.1901338101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health