Provider Demographics
NPI:1528107950
Name:MANIACEK, LUANNE
Entity type:Individual
Prefix:
First Name:LUANNE
Middle Name:
Last Name:MANIACEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 LITTLE PENINSULA RD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-1529
Mailing Address - Country:US
Mailing Address - Phone:847-528-2086
Mailing Address - Fax:
Practice Address - Street 1:2050 LARKIN AVE.
Practice Address - Street 2:SUITE 202
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-0000
Practice Address - Country:US
Practice Address - Phone:847-697-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL6386101YA0400X
IL1490010671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)