Provider Demographics
NPI:1083126486
Name:TRUSS NASH, DENISE
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:TRUSS NASH
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 1:407 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60433-2303
Mailing Address - Country:US
Mailing Address - Phone:708-513-6494
Mailing Address - Fax:
Practice Address - Street 1:1289 WINDHAM PKWY
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-1763
Practice Address - Country:US
Practice Address - Phone:630-759-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician