Healthcare Provider Details

I. General information

NPI: 1811045578
Provider Name (Legal Business Name): JENNIFER ELIZABETH DUQUE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

494 W BOUGHTON RD SUITE 1A
BOLINGBROOK IL
60440-1881
US

IV. Provider business mailing address

494 W BOUGHTON RD SUITE 1A
BOLINGBROOK IL
60440-1881
US

V. Phone/Fax

Practice location:
  • Phone: 630-251-2313
  • Fax:
Mailing address:
  • Phone: 630-251-2313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14303396-6004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH25287
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39005563A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-004108
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: