Provider Demographics
NPI:1538120993
Name:LUKACH, ALLEN L (LCSW, CADC III)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:L
Last Name:LUKACH
Suffix:
Gender:M
Credentials:LCSW, CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-1249
Mailing Address - Country:US
Mailing Address - Phone:920-743-9954
Mailing Address - Fax:
Practice Address - Street 1:620 N 12TH AVE
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-1249
Practice Address - Country:US
Practice Address - Phone:920-743-9954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7254-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39169900Medicaid