Provider Demographics
NPI:1629969100
Name:BASSEY, JOYCE
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:BASSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 LINCOLN MALL DR STE 2404747
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-3811
Mailing Address - Country:US
Mailing Address - Phone:773-574-3366
Mailing Address - Fax:
Practice Address - Street 1:4747 LINCOLN MALL DR STE 240
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-3812
Practice Address - Country:US
Practice Address - Phone:773-574-3366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2023205574363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health