Provider Demographics
NPI:1962842716
Name:LUCKETT, CAROLYN DANA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:DANA
Last Name:LUCKETT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:DANA
Other - Last Name:HOLMES, DENT, MEREDITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:6376 CLORE LN
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-8042
Mailing Address - Country:US
Mailing Address - Phone:260-437-8918
Mailing Address - Fax:
Practice Address - Street 1:6376 CLORE LN
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-8042
Practice Address - Country:US
Practice Address - Phone:260-437-8918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY166169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist