Provider Demographics
NPI:1740251214
Name:RUDDY, JULIE LYNN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:LYNN
Last Name:RUDDY
Suffix:
Gender:F
Credentials:PSYD
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Mailing Address - Street 1:3420 ILLINOIS ST
Mailing Address - Street 2:RECRUIT MENTAL HEALTH, USS TRANQUILLITY
Mailing Address - City:GREAT LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60088-3120
Mailing Address - Country:US
Mailing Address - Phone:847-688-7406
Mailing Address - Fax:847-688-7403
Practice Address - Street 1:3420 ILLINOIS ST
Practice Address - Street 2:RECRUIT MENTAL HEALTH, USS TRANQUILLITY
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-3120
Practice Address - Country:US
Practice Address - Phone:847-688-7406
Practice Address - Fax:847-688-7403
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical