Provider Demographics
NPI:1255853073
Name:WARDIN, LYDIA A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:A
Last Name:WARDIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6033 N SHERIDAN RD STE S7
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3013
Mailing Address - Country:US
Mailing Address - Phone:855-264-9355
Mailing Address - Fax:877-259-2359
Practice Address - Street 1:6033 N SHERIDAN RD STE S7
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-3013
Practice Address - Country:US
Practice Address - Phone:855-264-9355
Practice Address - Fax:877-259-2359
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009599103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist