Provider Demographics
NPI:1164646501
Name:HEGGELAND, JUDY ANN (MA,LCPC)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ANN
Last Name:HEGGELAND
Suffix:
Gender:F
Credentials:MA,LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 N NORTH CT
Mailing Address - Street 2:SUITE 240
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-8157
Mailing Address - Country:US
Mailing Address - Phone:847-202-6459
Mailing Address - Fax:
Practice Address - Street 1:675 N NORTH CT
Practice Address - Street 2:SUITE 240
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-8157
Practice Address - Country:US
Practice Address - Phone:847-202-6459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
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
IL01636418OtherBCBS