Provider Demographics
NPI:1295286383
Name:LUEKENGA WAY, LLC
Entity type:Organization
Organization Name:LUEKENGA WAY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUEKENGA
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:801-298-4327
Mailing Address - Street 1:415 MEDICAL DR
Mailing Address - Street 2:202-A
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4946
Mailing Address - Country:US
Mailing Address - Phone:801-298-4327
Mailing Address - Fax:801-298-4328
Practice Address - Street 1:415 MEDICAL DR
Practice Address - Street 2:202A
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4946
Practice Address - Country:US
Practice Address - Phone:801-298-4327
Practice Address - Fax:801-298-4328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT80296474101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty