Provider Demographics
NPI:1154930394
Name:SAWISCH, LUCAS
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:SAWISCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 S MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-4884
Mailing Address - Country:US
Mailing Address - Phone:309-820-7616
Mailing Address - Fax:
Practice Address - Street 1:502 S MORRIS AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-4884
Practice Address - Country:US
Practice Address - Phone:309-820-7616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health