Provider Demographics
NPI:1043950900
Name:DUNCAN, JESSIE (MA)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:DUNCAN
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 1:1945 W WILSON AVE STE 6114
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5259
Mailing Address - Country:US
Mailing Address - Phone:224-518-4547
Mailing Address - Fax:872-666-0032
Practice Address - Street 1:1945 W WILSON AVE STE 6114
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5259
Practice Address - Country:US
Practice Address - Phone:224-518-4547
Practice Address - Fax:872-666-0032
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017395101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional