Provider Demographics
NPI:1891850889
Name:FLAXMAN, JUDITH (PHD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:FLAXMAN
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 1:2310 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2109
Mailing Address - Country:US
Mailing Address - Phone:847-864-2723
Mailing Address - Fax:847-869-6028
Practice Address - Street 1:2530 CRAWFORD AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4970
Practice Address - Country:US
Practice Address - Phone:847-864-2723
Practice Address - Fax:847-869-6028
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1672639OtherBCBSIL PROVIDER NUMBER
IL1672639OtherBCBSIL PROVIDER NUMBER