Stacey Gail Lucterhand, MAT

Primary specialty

Other Specialist/TechnologistTaxonomy code 246Z00000X

License

863533 Issued in IL

Practice address

133 Ridge Rd
Highland Park, IL 60035-4338

Phone

(847) 962-9326

NPI assigned

Sep 11, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Stacey Gail Eisenberg Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568160000000",
    "number": "1295384337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 RIDGE RD",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600354338",
            "telephone_number": "847-962-9326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 RIDGE RD",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600354338",
            "telephone_number": "847-962-9326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCTERHAND",
        "first_name": "STACEY",
        "middle_name": "GAIL",
        "credential": "MAT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-11",
        "last_updated": "2019-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other",
            "state": "IL",
            "license": "863533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.sgltutoring.com",
            "affiliation": "N",
            "endpointDescription": "Organization Website",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "informational",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "website",
            "address_1": "133 Ridge Rd",
            "city": "Highland Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600354338",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "EISENBERG",
            "middle_name": "GAIL",
            "credential": "MAT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Other Specialist/Technologist in Highland Park, IL
• Providers in Highland Park, IL by specialty
• Other Specialist/Technologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.