Provider Demographics
NPI:1376207167
Name:LUKENSMEYER, KATELYN ELIZABETH ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:ELIZABETH ANN
Last Name:LUKENSMEYER
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 1:50 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5484
Mailing Address - Country:US
Mailing Address - Phone:630-473-3971
Mailing Address - Fax:
Practice Address - Street 1:50 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5484
Practice Address - Country:US
Practice Address - Phone:630-473-3971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0194101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical