Healthcare Provider Details

I. General information

NPI: 1487621595
Provider Name (Legal Business Name): JUDITH ANN CHANEY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 SUPPINGER LN
HIGHLAND IL
62249
US

IV. Provider business mailing address

217 SUPPINGER LN
HIGHLAND IL
62249
US

V. Phone/Fax

Practice location:
  • Phone: 618-654-5990
  • Fax: 618-654-9581
Mailing address:
  • Phone: 618-654-5990
  • Fax: 618-654-9581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: