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NPI Code Detail

MEDICARE: MS. LUQRETIA SHONETT STUCKEY LCSW, CADC

MEDICARE: MS. LUQRETIA SHONETT STUCKEY LCSW, CADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker34007699AIN
2101YA0400XAddiction (Substance Use Disorder) Counselor
31041C0700XClinical Social Worker149017980IL

General Provider Information

NPI Number : 1093003352
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LUQRETIA SHONETT STUCKEY LCSW, CADC
Provider Business Mailing Address
First Line : 2116 CHRISTINA ST
Second Line :
City : ROCKFORD
State : IL
Zip : 61104-7039
Country : US
Telephone Number : 815-742-1076
Fax Number :
Provider Business Practice Location Address
First Line : 1321 N 7TH ST
Second Line :
City : ROCHELLE
State : IL
Zip : 61068-1185
Country : US
Telephone Number : 815-562-3801
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2011
Last Update Date : 04/07/2026

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