Individual
MRS. EVONNE M. KUCKUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC, ATR
Contact information
Practice address
552 EDWARDSVILLE RD, TROY, IL 62294-1338
(618) 531-2435
Mailing address
534 COVENTRY RD, TROY, IL 62294-1743
(618) 531-2435
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180-004352
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06032019
BCBS PPO
IL
01
—
670554
HEALTHLINK HMO & PPO
—
Enumeration date
11/17/2006
Last updated
04/08/2025
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