Provider Demographics
NPI:1114933579
Name:SPEED, JUDITH LYNNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:LYNNE
Last Name:SPEED
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 867
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559
Mailing Address - Country:US
Mailing Address - Phone:707-224-6810
Mailing Address - Fax:707-361-8886
Practice Address - Street 1:1303 JEFFERSON ST.
Practice Address - Street 2:STE. 600A
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559
Practice Address - Country:US
Practice Address - Phone:707-224-6810
Practice Address - Fax:707-361-8886
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13944103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist