Individual
STACEY GAIL LUCTERHAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MAT
Contact information
Practice address
133 RIDGE RD, HIGHLAND PARK, IL 60035-4338
(847) 962-9326
Mailing address
133 RIDGE RD, HIGHLAND PARK, IL 60035-4338
(847) 962-9326
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
863533
IL
Other
Enumeration date
09/11/2019
Last updated
09/11/2019
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