Provider Demographics
NPI:1447033428
Name:DUKETT, JOEL (SSP, NCSP)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:DUKETT
Suffix:
Gender:M
Credentials:SSP, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 GUNDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3771
Mailing Address - Country:US
Mailing Address - Phone:708-795-2300
Mailing Address - Fax:
Practice Address - Street 1:3401 GUNDERSON AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3771
Practice Address - Country:US
Practice Address - Phone:708-303-4032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2446700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist