Individual
MIA SUDKAMP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
604 E ARMORY AVE, CHAMPAIGN, IL 61820-6240
(402) 413-5668
Mailing address
1503 BEAR CREEK DR, BLOOMINGTON, IL 61704-9472
(708) 285-0624
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
12752
NE
106H00000X
Marriage & Family Therapist
Primary
166001733
IL
Other
Enumeration date
09/03/2021
Last updated
03/11/2026
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