Provider Demographics
NPI:1972056539
Name:LUCKHAUPT, TAYLOR RAYLYNN (MAED SLP-CF)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RAYLYNN
Last Name:LUCKHAUPT
Suffix:
Gender:F
Credentials:MAED SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ALYCIA DR
Mailing Address - Street 2:APT 3
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-6829
Mailing Address - Country:US
Mailing Address - Phone:859-707-9787
Mailing Address - Fax:
Practice Address - Street 1:110 ALYCIA DR
Practice Address - Street 2:APT 3
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-6829
Practice Address - Country:US
Practice Address - Phone:859-707-9787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY168845235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist