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Individual

DR. JEREMY LUCE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MA, PSYD

Contact information

Practice address
2451 N LINCOLN AVE STE 206, CHICAGO, IL 60614-1509
(708) 320-9694
Mailing address
2451 N LINCOLN AVE STE 206, CHICAGO, IL 60614-1509
(708) 320-9694

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.0100007
IL
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
071.0100007
STATE LICENSE
IL
Enumeration date
10/07/2014
Last updated
05/07/2019
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