Healthcare Provider Details

I. General information

NPI: 1871168666
Provider Name (Legal Business Name): JUDITH LANDESS ED.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 09/20/2025
Certification Date: 09/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3649 MUNICIPAL DR
MCHENRY IL
60050-5434
US

IV. Provider business mailing address

3649 MUNICIPAL DR
MCHENRY IL
60050-5434
US

V. Phone/Fax

Practice location:
  • Phone: 815-985-7401
  • Fax:
Mailing address:
  • Phone: 815-985-7401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.017518
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2419061
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: