Provider Demographics
NPI:1093976425
Name:DIODATI-GLEASON, JUDITH N
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:N
Last Name:DIODATI-GLEASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:N
Other - Last Name:DIODATI-BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CAGS
Mailing Address - Street 1:3425 YORKSHIRE DR SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-4265
Mailing Address - Country:US
Mailing Address - Phone:360-701-4753
Mailing Address - Fax:
Practice Address - Street 1:3425 YORKSHIRE DR SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98513-4265
Practice Address - Country:US
Practice Address - Phone:360-701-4753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00019146101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor