Provider Demographics
NPI:1609818905
Name:LUEKENGA, RICHARD LAYNE JR (AUD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LAYNE
Last Name:LUEKENGA
Suffix:JR
Gender:M
Credentials:AUD
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Mailing Address - Street 1:1054 EAST RIVERSIDE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4825
Mailing Address - Country:US
Mailing Address - Phone:435-688-8991
Mailing Address - Fax:435-688-2122
Practice Address - Street 1:1054 EAST RIVERSIDE DR.,
Practice Address - Street 2:SUITE 201
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4825
Practice Address - Country:US
Practice Address - Phone:435-688-8991
Practice Address - Fax:435-688-2122
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-02-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT5935522-4101231H00000X
5935522-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD6362Medicaid
UTQ53758Medicare UPIN