Provider Demographics
NPI:1497853964
Name:SUTHERLAND, JUDY H (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:H
Last Name:SUTHERLAND
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 1:125 KEDZIE ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-4441
Mailing Address - Country:US
Mailing Address - Phone:847-869-2988
Mailing Address - Fax:
Practice Address - Street 1:125 KEDZIE ST
Practice Address - Street 2:APT. 1
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-4441
Practice Address - Country:US
Practice Address - Phone:847-869-2988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional