Provider Demographics
NPI:1215444906
Name:DUDA, MICHELLE (MS, LCPC, CADC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:DUDA
Suffix:
Gender:F
Credentials:MS, LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 N WESTERN AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3571
Mailing Address - Country:US
Mailing Address - Phone:312-566-8417
Mailing Address - Fax:
Practice Address - Street 1:1041 N WESTERN AVE FL 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3571
Practice Address - Country:US
Practice Address - Phone:312-566-8417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL33720101YA0400X
IL178011972101YP2500X
IL180012359101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional