Provider Demographics
NPI:1699811448
Name:PESKIND, JUDY R (LCPC)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:R
Last Name:PESKIND
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W GOLF RD
Mailing Address - Street 2:STE. #205
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195-5179
Mailing Address - Country:US
Mailing Address - Phone:847-519-2104
Mailing Address - Fax:847-519-1481
Practice Address - Street 1:120 W GOLF RD
Practice Address - Street 2:STE. #205
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195-5179
Practice Address - Country:US
Practice Address - Phone:847-519-2104
Practice Address - Fax:847-519-1481
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1633855OtherBCBS PROVIDER #