Provider Demographics
NPI:1114230224
Name:LAZUKA, PATRICIA R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:R
Last Name:LAZUKA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17204 LAFLIN AVE
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-1842
Mailing Address - Country:US
Mailing Address - Phone:708-297-0299
Mailing Address - Fax:
Practice Address - Street 1:15750 S BELL RD
Practice Address - Street 2:SUITE 2E
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-8412
Practice Address - Country:US
Practice Address - Phone:708-301-6311
Practice Address - Fax:408-882-0891
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-17
Last Update Date:2010-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0141591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical