Provider Demographics
NPI:1790175248
Name:LAUKANT, AMANDA LYN (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYN
Last Name:LAUKANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9346 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1216
Mailing Address - Country:US
Mailing Address - Phone:212-439-1124
Mailing Address - Fax:
Practice Address - Street 1:9346 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1216
Practice Address - Country:US
Practice Address - Phone:212-439-1124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0891011041C0700X
IL1490258551041C0700X
COCSW.099237511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical