Individual
KIMBERLY LUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10111 S VERNON AVE, CHICAGO, IL 60628-2235
(773) 220-9215
Mailing address
7715 S COTTAGE GROVE AVE UNIT 198884, CHICAGO, IL 60619-2082
(773) 220-9215
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1780147127
IL
Other
Enumeration date
12/29/2023
Last updated
12/29/2023
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