Provider Demographics
NPI:1679837728
Name:PATTERSON, JOELLYN MARIE (BA, CADC)
Entity Type:Individual
Prefix:MRS
First Name:JOELLYN
Middle Name:MARIE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:BA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6421 ASH DR
Mailing Address - Street 2:
Mailing Address - City:MORO
Mailing Address - State:IL
Mailing Address - Zip Code:62067-1625
Mailing Address - Country:US
Mailing Address - Phone:618-709-9735
Mailing Address - Fax:
Practice Address - Street 1:50 NORTHGATE INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-6805
Practice Address - Country:US
Practice Address - Phone:618-512-1792
Practice Address - Fax:618-877-9250
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3588101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)