Provider Demographics
NPI:1558322271
Name:LUEDKE, MARGARET ANN (PHD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANN
Last Name:LUEDKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:M.
Other - Middle Name:ANN
Other - Last Name:LUEDKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:66 TIMBEROAK CT
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-3459
Mailing Address - Country:US
Mailing Address - Phone:434-237-6236
Mailing Address - Fax:434-237-9155
Practice Address - Street 1:66 TIMBEROAK CT
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-3459
Practice Address - Country:US
Practice Address - Phone:434-237-6236
Practice Address - Fax:434-237-9155
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000805103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA254585000OtherMAGELLAN
VA217831OtherVALUE OPTIONS
VA067132OtherBLUE CROSS BLUE SHIELD
VA680000066Medicare ID - Type Unspecified