Provider Demographics
NPI:1013026129
Name:RASTOGI, MUDITA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MUDITA
Middle Name:
Last Name:RASTOGI
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 1:415 E GOLF RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4078
Mailing Address - Country:US
Mailing Address - Phone:847-258-7273
Mailing Address - Fax:847-981-0878
Practice Address - Street 1:415 E GOLF RD
Practice Address - Street 2:SUITE 115
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4078
Practice Address - Country:US
Practice Address - Phone:847-258-7273
Practice Address - Fax:847-981-0878
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166-000369106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist