Provider Demographics
NPI:1487731014
Name:DUKE, DENISE M (EDD, LP)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:M
Last Name:DUKE
Suffix:
Gender:F
Credentials:EDD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 8TH ST S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5062
Mailing Address - Country:US
Mailing Address - Phone:701-241-9281
Mailing Address - Fax:701-298-8321
Practice Address - Street 1:3101 8TH ST S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5062
Practice Address - Country:US
Practice Address - Phone:701-241-9281
Practice Address - Fax:701-298-8321
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3533103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN889948700Medicaid
ND1453233Medicaid