Organization Active NPI

Judith a. Holmes, PHD., P.C.

  • Clinical Neuropsychologist
  • Park Ridge, IL
National Provider Identifier
1962596023
Registry record updated Aug 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
071004106 Issued in IL
Legal business name
JUDITH A. HOLMES, PHD., P.C.
Practice address
1440 Renaissance Drive
Suite 200
Park Ridge, IL 60068
Phone
(847) 296-3442
Fax
(847) 296-3543
NPI assigned
Oct 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Judith A. Holmes, PH.D.
Title
President
Phone
(847) 296-3442

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103G00000X 071004106 IL Primary

Addresses

Primary practice location

1440 Renaissance Drive
Suite 200
Park Ridge, IL 60068

Mailing address

1440 Renaissance Drive
Suite 200
Park Ridge, IL 60068
Phone (847) 296-3442

Other identifiers 1

IdentifierTypeStateIssuer
01673546OtherILBLUE SHIELD

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376611200000",
    "number": "1962596023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 RENAISSANCE DRIVE",
            "address_2": "SUITE 200",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "60068",
            "telephone_number": "847-296-3442",
            "fax_number": "847-296-3543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 RENAISSANCE DRIVE",
            "address_2": "SUITE 200",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "60068",
            "telephone_number": "847-296-3442",
            "fax_number": "847-296-3543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUDITH A. HOLMES, PHD., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2013-08-16",
        "status": "A",
        "authorized_official_last_name": "HOLMES",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-296-3442",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "IL",
            "license": "071004106",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "01673546",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.