Provider Demographics
NPI:1932988177
Name:SUMMERS, JUDITH UDOKA (BCBA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:UDOKA
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:UDOKA
Other - Last Name:MBADIWE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:1515 W MORSE AVE APT 314
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-3351
Mailing Address - Country:US
Mailing Address - Phone:773-502-5881
Mailing Address - Fax:
Practice Address - Street 1:1515 W MORSE AVE APT 314
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-3351
Practice Address - Country:US
Practice Address - Phone:773-502-5881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-23-67168103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty