Provider Demographics
NPI:1083897359
Name:JUDD, SUE ANN
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ANN
Last Name:JUDD
Suffix:
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 1:1071 E 100 S
Mailing Address - Street 2:SUITE C-7
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3070
Mailing Address - Country:US
Mailing Address - Phone:435-652-1202
Mailing Address - Fax:
Practice Address - Street 1:1071 E 100 S
Practice Address - Street 2:SUITE C-7
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3070
Practice Address - Country:US
Practice Address - Phone:435-652-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13364101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)