Provider Demographics
NPI:1073656138
Name:LOUDON, JUDY BLANCHARD (CNS)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:BLANCHARD
Last Name:LOUDON
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:LYNN
Other - Last Name:LOUDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNS
Mailing Address - Street 1:610 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47901-1451
Mailing Address - Country:US
Mailing Address - Phone:765-423-2638
Mailing Address - Fax:
Practice Address - Street 1:610 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47901-1451
Practice Address - Country:US
Practice Address - Phone:765-423-2638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000037A364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health