Provider Demographics
NPI:1134309487
Name:DIRKS, JUDITH KAY (M A)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:KAY
Last Name:DIRKS
Suffix:
Gender:F
Credentials:M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 SANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-3133
Mailing Address - Country:US
Mailing Address - Phone:509-946-7092
Mailing Address - Fax:
Practice Address - Street 1:1213 N MORAIN LOOP
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1541
Practice Address - Country:US
Practice Address - Phone:509-947-4628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-04
Last Update Date:2007-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004749101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health