Healthcare Provider Details

I. General information

NPI: 1114218856
Provider Name (Legal Business Name): JULIE MARIE LUDWICK A.T.R.-B.C, L.C.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4527 N KEOKUK AVE
CHICAGO IL
60630-4220
US

IV. Provider business mailing address

4527 N KEOKUK AVE
CHICAGO IL
60630-4220
US

V. Phone/Fax

Practice location:
  • Phone: 773-633-6569
  • Fax:
Mailing address:
  • Phone: 773-633-6569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number180.007792
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180.007792
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.007792
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number146-36
License Number StateWI
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.007792
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: