Provider Demographics
NPI:1245570456
Name:DEWEESE, NANCY J (LCPC)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:J
Last Name:DEWEESE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 PARK AVE # 2
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2328
Mailing Address - Country:US
Mailing Address - Phone:920-889-0695
Mailing Address - Fax:
Practice Address - Street 1:122 PARK AVE # 2
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2328
Practice Address - Country:US
Practice Address - Phone:920-889-0695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL180012291101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health