Provider Demographics
NPI:1780760462
Name:LUCKE, SHERRI P (LMP)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:P
Last Name:LUCKE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:SHERRI
Other - Middle Name:P
Other - Last Name:PERRENOUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:201 160TH ST S
Practice Address - Street 2:STE 301
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8508
Practice Address - Country:US
Practice Address - Phone:253-531-4100
Practice Address - Fax:253-531-3795
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018902225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8930866OtherCRIME VICTIMS
WA8166LUOtherREGENCE BLUE SHIELD
WA183083OtherDEPT OF LABOR & INDUSTRY