| Judith A. Holmes, Phd., P.c. | |
|
1440 Renaissance Drive Suite 200 Park Ridge IL 60068 | |
| (847) 296-3442 | |
| (847) 296-3543 |
| Full Name | Judith A. Holmes, Phd., P.c. |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 1440 Renaissance Drive, Park Ridge, Illinois |
| Authorized Official Name and Position | Judith A. Holmes (PRESIDENT) |
| Authorized Official Contact | 8472963442 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Judith A. Holmes, Phd., P.c. 1440 Renaissance Drive Suite 200 Park Ridge IL 60068 Ph: (847) 296-3442 | Judith A. Holmes, Phd., P.c. 1440 Renaissance Drive Suite 200 Park Ridge IL 60068 Ph: (847) 296-3442 |
| NPI Number | 1962596023 |
|---|---|
| Provider Enumeration Date | 10/03/2006 |
| Last Update Date | 08/16/2013 |
| Medicare PECOS PAC ID | 1254313067 |
|---|---|
| Medicare Enrollment ID | O20040604000700 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962596023 | NPI | - | NPPES |
| 01673546 | Other | IL | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 071004106 (Illinois) | Primary |
| Provider Name | Judith A Holmes |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013047018 PECOS PAC ID: 2769464585 Enrollment ID: I20040607000590 |
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