Provider Demographics
NPI:1861490328
Name:LUKASIEWICZ, PATRICIA M (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:M
Last Name:LUKASIEWICZ
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 1:97 HAMBURG ST
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-2139
Mailing Address - Country:US
Mailing Address - Phone:716-652-6464
Mailing Address - Fax:716-652-6499
Practice Address - Street 1:97 HAMBURG ST
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-2139
Practice Address - Country:US
Practice Address - Phone:716-652-6464
Practice Address - Fax:716-652-6499
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004094-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000640031002OtherBLUECROSS BLUESHIELD WNY
NY9211069OtherINDEPENDENT HEALTH
NY00025349301OtherUNIVERA HEALTHCARE