Provider Demographics
NPI:1730245960
Name:WILKE, JUDITH ANNE
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANNE
Last Name:WILKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 S CUYLER AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-3515
Mailing Address - Country:US
Mailing Address - Phone:708-383-8667
Mailing Address - Fax:
Practice Address - Street 1:8340 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2466
Practice Address - Country:US
Practice Address - Phone:847-679-4977
Practice Address - Fax:847-679-4945
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist