Provider Demographics
NPI:1649289463
Name:CHODACKI, JULIE (PSYD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:CHODACKI
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 1:65 E WACKER PL
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7296
Mailing Address - Country:US
Mailing Address - Phone:312-201-5900
Mailing Address - Fax:312-201-0250
Practice Address - Street 1:65 E WACKER PL
Practice Address - Street 2:SUITE 2100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7296
Practice Address - Country:US
Practice Address - Phone:312-201-5900
Practice Address - Fax:312-201-0250
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK25884OtherMEDICARE ID-UNSPECIFIED