Individual
ELIZABETH BLANN LUTKEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
207 W JACKSON ST, RIDGELAND, MS 39157-2355
(601) 362-0859
Mailing address
2457 WILD VALLEY DR, JACKSON, MS 39211-6233
(662) 822-6266
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S3866
MS
Other
Enumeration date
11/09/2015
Last updated
11/09/2015
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