Provider Demographics
NPI:1043220023
Name:JUDSON-HARMS, JENNIFER JANE (LISW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JANE
Last Name:JUDSON-HARMS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 290TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50659-9012
Mailing Address - Country:US
Mailing Address - Phone:641-330-0901
Mailing Address - Fax:641-394-3759
Practice Address - Street 1:23 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50659-2115
Practice Address - Country:US
Practice Address - Phone:641-330-0901
Practice Address - Fax:641-394-3759
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA015081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0476408Medicaid
IAP65200Medicare UPIN
IAI7038Medicare ID - Type Unspecified