Provider Demographics
NPI:1033570734
Name:FYNEWEVER, JUDY I
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:
Last Name:FYNEWEVER
Suffix:I
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 1:1010 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-1432
Mailing Address - Country:US
Mailing Address - Phone:906-281-0562
Mailing Address - Fax:
Practice Address - Street 1:1010 6TH AVE
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-1432
Practice Address - Country:US
Practice Address - Phone:906-281-0562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002560101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional