Provider Demographics
NPI:1134385792
Name:HUDETZ, BERNADETTE ATTOLICO (PSYD)
Entity type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:ATTOLICO
Last Name:HUDETZ
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 1:139 W. RAND RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-3982
Mailing Address - Country:US
Mailing Address - Phone:847-259-8583
Mailing Address - Fax:847-259-8935
Practice Address - Street 1:139 W. RAND RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3982
Practice Address - Country:US
Practice Address - Phone:847-259-8583
Practice Address - Fax:847-259-8935
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005422103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist