Provider Demographics
NPI:1023869922
Name:DUVALL, JESSE
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:DUVALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 SW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-2603
Mailing Address - Country:US
Mailing Address - Phone:785-289-8601
Mailing Address - Fax:
Practice Address - Street 1:2611 SW 17TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-2603
Practice Address - Country:US
Practice Address - Phone:785-249-4173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101200000XBehavioral Health & Social Service ProvidersDrama Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health