1629315817 NPI number — MRS. JESSICA VOS LUEKING MS, LPC-MH, NCC, LAC

Table of content: MRS. JESSICA VOS LUEKING MS, LPC-MH, NCC, LAC (NPI 1629315817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629315817 NPI number — MRS. JESSICA VOS LUEKING MS, LPC-MH, NCC, LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUEKING
Provider First Name:
JESSICA
Provider Middle Name:
VOS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC-MH, NCC, LAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629315817
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6209 S. PINNACLE PL.
Provider Second Line Business Mailing Address:
STE. 102
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-988-8131
Provider Business Mailing Address Fax Number:
605-610-2839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 W 69TH ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57108-2438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-310-0032
Provider Business Practice Location Address Fax Number:
605-271-0200
Provider Enumeration Date:
01/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  LPC-7173 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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