Healthcare Provider Details

I. General information

NPI: 1144751645
Provider Name (Legal Business Name): JUDITH BELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2017
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10809 S STATE ST
CHICAGO IL
60628-3409
US

IV. Provider business mailing address

8251 S RHODES AVE
CHICAGO IL
60619-5005
US

V. Phone/Fax

Practice location:
  • Phone: 773-455-5262
  • Fax: 866-240-8885
Mailing address:
  • Phone: 773-818-9607
  • Fax: 866-240-8885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number041237741
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: