Healthcare Provider Details

I. General information

NPI: 1366752081
Provider Name (Legal Business Name): JUDY MARIE KRAMER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W BOUGHTON RD #104
BOLINGBROOK IL
60440-1892
US

IV. Provider business mailing address

440 W BOUGHTON RD #104
BOLINGBROOK IL
60440-1892
US

V. Phone/Fax

Practice location:
  • Phone: 331-318-1881
  • Fax: 630-863-7293
Mailing address:
  • Phone: 331-318-1881
  • Fax: 630-863-7293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149008538
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: