Healthcare Provider Details

I. General information

NPI: 1770064032
Provider Name (Legal Business Name): MRS. RENEE LUKOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27754 BLUE GRASS DR UNIT C
CHANNAHON IL
60410-8783
US

IV. Provider business mailing address

24750 W MEADOWLARK DR
CHANNAHON IL
60410-5143
US

V. Phone/Fax

Practice location:
  • Phone: 815-531-4224
  • Fax:
Mailing address:
  • Phone: 708-668-3394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: