Provider Demographics
NPI:1942322904
Name:MILLER, JUDITH ANNE (PSYD, CDAC)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PSYD, CDAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N WESTMORELAND RD
Mailing Address - Street 2:SUITE #216
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1674
Mailing Address - Country:US
Mailing Address - Phone:847-604-9882
Mailing Address - Fax:847-816-8621
Practice Address - Street 1:900 N WESTMORELAND RD
Practice Address - Street 2:SUITE #216
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1674
Practice Address - Country:US
Practice Address - Phone:847-604-9882
Practice Address - Fax:847-816-8621
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
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
IL7443194OtherAETNA PIN#
IL04927677OtherBLUE CROSS BLUE SHIELD ID