Provider Demographics
NPI:1447428628
Name:GARRISON, JUDITH JULIA (RN-BC, CADC)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:JULIA
Last Name:GARRISON
Suffix:
Gender:F
Credentials:RN-BC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 E VAN BUREN AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-4947
Mailing Address - Country:US
Mailing Address - Phone:630-865-8616
Mailing Address - Fax:630-848-0445
Practice Address - Street 1:113 E VAN BUREN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-4947
Practice Address - Country:US
Practice Address - Phone:630-865-8616
Practice Address - Fax:630-848-0445
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL6666101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)