Healthcare Provider Details

I. General information

NPI: 1255294831
Provider Name (Legal Business Name): SAMANTHA LUCKO LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24012 W MAIN ST STE 106
PLAINFIELD IL
60544-2227
US

IV. Provider business mailing address

24012 W MAIN ST STE 106
PLAINFIELD IL
60544-2227
US

V. Phone/Fax

Practice location:
  • Phone: 708-466-3934
  • Fax:
Mailing address:
  • Phone: 708-466-3934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.012403
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: