MEDICARE: JUDY R PESKIND LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1633855	OTHER	IL	BCBS PROVIDER #

General Provider Information

NPI Number	:	1699811448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY R PESKIND LCPC

Provider Business Mailing Address
First Line	:	120 W GOLF RD
Second Line	:	STE. #205
City	:	SCHAUMBURG
State	:	IL
Zip	:	60195-5179
Country	:	US
Telephone Number	:	847-519-2104
Fax Number	:	847-519-1481

Provider Business Practice Location Address
First Line	:	120 W GOLF RD
Second Line	:	STE. #205
City	:	SCHAUMBURG
State	:	IL
Zip	:	60195-5179
Country	:	US
Telephone Number	:	847-519-2104
Fax Number	:	847-519-1481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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