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Contact Information

JEREMY T BIDWELL, PhD
111 DEAN ST
WOODSTOCK, IL60098-3220
 Phone: 815-344-5061
 Fax: 815-344-5072
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Prescribing (Medical)

103TP0016X 62 Psychologist, Clinical
 

Clinical

103TC0700X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for JEREMY T BIDWELL · (Male)

NPI Number 1609108703
Status Active
Credentials PhD
Entity Individual
Enumeration date 02/01/2010
Last updated 12/15/2021 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • IL License # 071.007831
  • IL License # 074.000011
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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