Provider Demographics
NPI:1346875234
Name:JUDD, TIMOTHY HART
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:HART
Last Name:JUDD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 HOME AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2912
Mailing Address - Country:US
Mailing Address - Phone:773-633-9508
Mailing Address - Fax:
Practice Address - Street 1:3210 HOME AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2912
Practice Address - Country:US
Practice Address - Phone:773-633-9508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health