1194792705 NPI number — MRS. FELICIA ANNE DUDEK MS LCPC CADC

Table of content: MRS. FELICIA ANNE DUDEK MS LCPC CADC (NPI 1194792705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194792705 NPI number — MRS. FELICIA ANNE DUDEK MS LCPC CADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUDEK
Provider First Name:
FELICIA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS LCPC CADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FUNK
Provider Other First Name:
FELICIA
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194792705
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4049 BORDEAUX DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60062-2139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-729-3548
Provider Business Mailing Address Fax Number:
847-714-1596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 NORTH MICHIGAN AV
Provider Second Line Business Practice Location Address:
ROOM 1926
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60602-3615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-729-3548
Provider Business Practice Location Address Fax Number:
847-714-1597
Provider Enumeration Date:
03/02/2006

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: 101Y00000X , 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)





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