Healthcare Provider Details

I. General information

NPI: 1376450155
Provider Name (Legal Business Name): DESDEMONA ELIZABETH LOUCADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 GLENWOOD AVE
JOLIET IL
60435-5481
US

IV. Provider business mailing address

2301 GLENWOOD AVE
JOLIET IL
60435-5481
US

V. Phone/Fax

Practice location:
  • Phone: 630-660-5824
  • Fax: 815-730-8173
Mailing address:
  • Phone: 630-660-5824
  • Fax: 815-730-8173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178023418
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: