Provider Demographics
NPI:1912099680
Name:DUEWEKE, JOSEPH RONALD (LMSW)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RONALD
Last Name:DUEWEKE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7611 STARVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COTTRELLVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48039-2910
Mailing Address - Country:US
Mailing Address - Phone:810-765-7085
Mailing Address - Fax:
Practice Address - Street 1:215 NORTH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-1716
Practice Address - Country:US
Practice Address - Phone:586-466-9744
Practice Address - Fax:586-466-9961
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010617461041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM83680004Medicare ID - Type Unspecified