Provider Demographics
NPI:1124095492
Name:SKERCHOCK, JUDITH ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANN
Last Name:SKERCHOCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 TAYLORSPORT LN
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1543
Mailing Address - Country:US
Mailing Address - Phone:847-446-3132
Mailing Address - Fax:847-446-6289
Practice Address - Street 1:25 E WASHINGTON ST
Practice Address - Street 2:STE 1801
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602
Practice Address - Country:US
Practice Address - Phone:312-263-1777
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-04
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071002972101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
17275282OtherAPA MEMBER NUMBER
IL071002972OtherSTATE LICENSE
33433OtherNATIONAL REGISTER HEALTH
33433OtherNATIONAL REGISTER HEALTH