Provider Demographics
NPI:1043581879
Name:KELSEY JUDGE, ABIGAIL LYN (PLPC)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:LYN
Last Name:KELSEY JUDGE
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 WASHINGTON SREET STE. 401
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114
Mailing Address - Country:US
Mailing Address - Phone:816-561-2374
Mailing Address - Fax:816-561-2374
Practice Address - Street 1:4010 WASHINGTON ST
Practice Address - Street 2:SUITE 401
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2609
Practice Address - Country:US
Practice Address - Phone:816-561-2374
Practice Address - Fax:816-561-2374
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011024743101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional