Provider Demographics
NPI:1609205657
Name:GADISSON, JET (DNP)
Entity type:Individual
Prefix:
First Name:JET
Middle Name:
Last Name:GADISSON
Suffix:
Gender:U
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 OAKMONT LN
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5551
Mailing Address - Country:US
Mailing Address - Phone:630-861-1500
Mailing Address - Fax:
Practice Address - Street 1:750 OAKMONT LN
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-5551
Practice Address - Country:US
Practice Address - Phone:630-861-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-09
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000820363L00000X
IL209.010882363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health