MEDICARE: TYZERIA LUSTER

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
1	1041C0700X	Clinical Social Worker		IL

General Provider Information

NPI Number	:	1174455224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYZERIA LUSTER

Provider Business Mailing Address
First Line	:	3125 BERNICE RD APT 1
Second Line	:
City	:	LANSING
State	:	IL
Zip	:	60438-1685
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3125 BERNICE RD APT 1
Second Line	:
City	:	LANSING
State	:	IL
Zip	:	60438-1685
Country	:	US
Telephone Number	:	630-381-7755
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “ TYZERIA LUSTER ” Practice Location

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