Provider Demographics
NPI:1992963284
Name:LOUCKS, ANGELA JOY (MA CCCA)
Entity type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:JOY
Last Name:LOUCKS
Suffix:
Gender:F
Credentials:MA CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 W 6TH SUITE 216
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044
Mailing Address - Country:US
Mailing Address - Phone:785-841-1107
Mailing Address - Fax:785-841-1173
Practice Address - Street 1:1112 W 6TH
Practice Address - Street 2:SUITE 216
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044
Practice Address - Country:US
Practice Address - Phone:785-841-1107
Practice Address - Fax:785-841-1173
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2153231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist