Provider Demographics
NPI:1518750579
Name:LUKACH, HEATHER (LICSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:LUKACH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5519 N DIVERSEY BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5202
Mailing Address - Country:US
Mailing Address - Phone:414-628-0038
Mailing Address - Fax:
Practice Address - Street 1:5519 N DIVERSEY BLVD
Practice Address - Street 2:
Practice Address - City:WHITEFISH BAY
Practice Address - State:WI
Practice Address - Zip Code:53217-5202
Practice Address - Country:US
Practice Address - Phone:414-628-0038
Practice Address - Fax:414-628-0038
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8118-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical