Provider Demographics
NPI:1659663391
Name:LUECK, KORY E (CSW)
Entity Type:Individual
Prefix:MRS
First Name:KORY
Middle Name:E
Last Name:LUECK
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:MS
Other - First Name:KORY
Other - Middle Name:E
Other - Last Name:BRANDAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1811 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-2745
Mailing Address - Country:US
Mailing Address - Phone:608-633-2403
Mailing Address - Fax:
Practice Address - Street 1:1407 SAINT ANDREW ST STE 100
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-2378
Practice Address - Country:US
Practice Address - Phone:608-372-3109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9567-120171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator