Organization
MARTIE RYAN LUKANICH PSY D PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIE RYAN LUKANICH PSYD (PRESIDENT)
(708) 829-8277
Entity
Organization
Contact information
Practice address
9631 W 153RD ST STE 37, ORLAND PARK, IL 60462-3778
(708) 829-8277
Mailing address
521 BELL AVE, LA GRANGE, IL 60525-5903
(708) 829-8277
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1497886196
NPI
—
01
—
1740403476
NPI
—
Enumeration date
09/10/2021
Last updated
09/10/2021
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