Provider Demographics
NPI:1811045578
Name:DUQUE, JENNIFER ELIZABETH (MA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:DUQUE
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 1:494 W BOUGHTON RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1881
Mailing Address - Country:US
Mailing Address - Phone:630-251-0447
Mailing Address - Fax:630-701-2828
Practice Address - Street 1:494 W BOUGHTON RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1881
Practice Address - Country:US
Practice Address - Phone:630-251-0447
Practice Address - Fax:630-701-2828
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional