Provider Demographics
NPI:1538119714
Name:FUSEK, JOYCE D (PSYD)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:D
Last Name:FUSEK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 THUNDER ROCK TRL
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:IL
Mailing Address - Zip Code:61036-9593
Mailing Address - Country:US
Mailing Address - Phone:541-731-3431
Mailing Address - Fax:
Practice Address - Street 1:17 THUNDER ROCK TRL
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:IL
Practice Address - Zip Code:61036-9593
Practice Address - Country:US
Practice Address - Phone:312-550-2935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1536103T00000X
TX31497103T00000X
IA101964103T00000X
IL071006070103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR181823Medicaid
P322231Medicare UPIN
OR181823Medicaid