Provider Demographics
NPI:1386716330
Name:BAKSHY, JUDY (PHD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:
Last Name:BAKSHY
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 1:709 LAPORTE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2021
Mailing Address - Country:US
Mailing Address - Phone:847-251-6452
Mailing Address - Fax:847-251-6480
Practice Address - Street 1:5225 OLD ORCHARD RD
Practice Address - Street 2:SUITE 27A
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4405
Practice Address - Country:US
Practice Address - Phone:847-967-6462
Practice Address - Fax:847-583-8227
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71002298103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL235430Medicare ID - Type Unspecified