Basic Information
| Provider Information | |||||||||
| NPI: | 1003292442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUFFY-HOOK | ||||||||
| FirstName: | JACQUELINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1112 W BOUGHTON RD | ||||||||
| Address2: | #120 | ||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604401508 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1112 W BOUGHTON RD | ||||||||
| Address2: | #120 | ||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604401508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309627784 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2015 | ||||||||
| LastUpdateDate: | 08/07/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 149-005302 | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.