Provider Demographics
NPI:1306077607
Name:VUCKO, LISA KRISTYNE (MA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KRISTYNE
Last Name:VUCKO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3278
Mailing Address - Country:US
Mailing Address - Phone:219-663-6353
Mailing Address - Fax:219-947-3224
Practice Address - Street 1:250 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3278
Practice Address - Country:US
Practice Address - Phone:219-663-6353
Practice Address - Fax:219-947-3224
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health