Healthcare Provider Details

I. General information

NPI: 1174846141
Provider Name (Legal Business Name): JOY A VALKO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOY A PREPEJCHAL PSYD

II. Dates (important events)

Enumeration Date: 03/05/2010
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 DAKOTA ST STE A
CRYSTAL LAKE IL
60012
US

IV. Provider business mailing address

650 DAKOTA ST STE A
CRYSTAL LAKE IL
60012-3744
US

V. Phone/Fax

Practice location:
  • Phone: 815-455-6000
  • Fax: 815-206-2822
Mailing address:
  • Phone: 815-455-6000
  • Fax: 815-206-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071007842
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: