Provider Demographics
NPI:1669887469
Name:LUKASIEWICZ, HOLLY (LMSW)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:LUKASIEWICZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:J
Other - Last Name:JANSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6200 AURORA AVE
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-2800
Mailing Address - Country:US
Mailing Address - Phone:515-331-0303
Mailing Address - Fax:
Practice Address - Street 1:300 68TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-6927
Practice Address - Country:US
Practice Address - Phone:616-455-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0730481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical