1124095492 NPI number — DR. JUDITH ANN SKERCHOCK PH.D.

Table of content: DR. JUDITH ANN SKERCHOCK PH.D. (NPI 1124095492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124095492 NPI number — DR. JUDITH ANN SKERCHOCK PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKERCHOCK
Provider First Name:
JUDITH
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124095492
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1129 TAYLORSPORT LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINNETKA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60093-1543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-446-3132
Provider Business Mailing Address Fax Number:
847-446-6289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 E WASHINGTON ST
Provider Second Line Business Practice Location Address:
STE 1801
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-263-1777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  071002972 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 17275282 . This is a "APA MEMBER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 071002972 . This is a "STATE LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 33433 . This is a "NATIONAL REGISTER HEALTH" identifier . This identifiers is of the category "OTHER".