Provider Demographics
NPI:1568629004
Name:TISDALL, JUDY (PSYD, LCPC)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:
Last Name:TISDALL
Suffix:
Gender:F
Credentials:PSYD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 N PLUM GROVE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5189
Mailing Address - Country:US
Mailing Address - Phone:847-413-9001
Mailing Address - Fax:847-413-0491
Practice Address - Street 1:953 N PLUM GROVE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5189
Practice Address - Country:US
Practice Address - Phone:847-413-9001
Practice Address - Fax:847-413-0491
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst