Joel Dukett, SSP, NCSP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2446700 Issued in IL

Practice address

3401 Gunderson Ave
Berwyn, IL 60402-3771

Phone

(708) 303-4032

NPI assigned

Aug 15, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• South Berwyn School Dist 100

  • Local Education Agency (LEA)
  • Berwyn, IL
  • NPI 1568630549
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1692057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692057600000",
    "number": "1447033428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 GUNDERSON AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023771",
            "telephone_number": "708-795-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 GUNDERSON AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023771",
            "telephone_number": "708-303-4032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUKETT",
        "first_name": "JOEL",
        "credential": "SSP, NCSP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-15",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "2446700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Berwyn, IL
• Providers in Berwyn, IL by specialty
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.