Provider Demographics
NPI:1710320957
Name:LUKENBILL, KATHY (MS, DT)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:
Last Name:LUKENBILL
Suffix:
Gender:F
Credentials:MS, DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 SEWARD ST
Mailing Address - Street 2:# L-2
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2837
Mailing Address - Country:US
Mailing Address - Phone:773-412-8726
Mailing Address - Fax:
Practice Address - Street 1:835 SEWARD ST
Practice Address - Street 2:# L-2
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2837
Practice Address - Country:US
Practice Address - Phone:773-412-8726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional