Healthcare Provider Details

I. General information

NPI: 1841629821
Provider Name (Legal Business Name): JUDITH MATTOX NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2013
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11845 SOUTHWEST HWY UNIT 12
PALOS HEIGHTS IL
60463-1599
US

IV. Provider business mailing address

11845 SOUTHWEST HWY UNIT 12
PALOS HEIGHTS IL
60463-1599
US

V. Phone/Fax

Practice location:
  • Phone: 708-923-5422
  • Fax: 708-923-5458
Mailing address:
  • Phone: 708-923-5422
  • Fax: 708-923-5458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209010899
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209010899
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: