Provider Demographics
NPI:1811414188
Name:DUEWEKE, HEIDI (LCPC, CRSS)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:DUEWEKE
Suffix:
Gender:F
Credentials:LCPC, CRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 S WESTERN AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-2264
Mailing Address - Country:US
Mailing Address - Phone:734-560-2991
Mailing Address - Fax:
Practice Address - Street 1:3638 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-2727
Practice Address - Country:US
Practice Address - Phone:773-537-3170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-27
Last Update Date:2017-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health