Provider Demographics
NPI:1982937660
Name:SCUDDER, CHRISTINE (MSW, LSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:SCUDDER
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10319 S HAMLIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-3113
Mailing Address - Country:US
Mailing Address - Phone:773-239-8963
Mailing Address - Fax:773-751-2002
Practice Address - Street 1:10319 S HAMLIN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-3113
Practice Address - Country:US
Practice Address - Phone:773-239-8963
Practice Address - Fax:773-751-2002
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.011886104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker