Provider Demographics
NPI:1558772301
Name:LUCKEY, LIKECIA (MS,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LIKECIA
Middle Name:
Last Name:LUCKEY
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6390 COLONIAL GRAND DR
Mailing Address - Street 2:207
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3534
Mailing Address - Country:US
Mailing Address - Phone:813-317-3463
Mailing Address - Fax:
Practice Address - Street 1:6390 COLONIAL GRAND DR
Practice Address - Street 2:207
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3534
Practice Address - Country:US
Practice Address - Phone:813-317-3463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12028235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist