Healthcare Provider Details

I. General information

NPI: 1427848233
Provider Name (Legal Business Name): JOSHUA HULETT LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 N HERSHEY RD STE C
BLOOMINGTON IL
61704-3560
US

IV. Provider business mailing address

55 E JACKSON BLVD STE 1500
CHICAGO IL
60604-4184
US

V. Phone/Fax

Practice location:
  • Phone: 877-381-6538
  • Fax: 309-590-5990
Mailing address:
  • Phone: 312-663-1300
  • Fax: 312-663-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150113005
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: