Provider Demographics
NPI:1740550581
Name:STEVENS-BUCK, LISA KAY (CADC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:STEVENS-BUCK
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:KAY
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2323 WINDISH DR
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-9780
Mailing Address - Country:US
Mailing Address - Phone:309-344-2323
Mailing Address - Fax:309-344-4368
Practice Address - Street 1:137 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:KEWANEE
Practice Address - State:IL
Practice Address - Zip Code:61443-3703
Practice Address - Country:US
Practice Address - Phone:309-852-4331
Practice Address - Fax:309-854-0122
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL30044101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)