Provider Demographics
NPI:1144394982
Name:RUDO, NAOMI (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:NAOMI
Middle Name:
Last Name:RUDO
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W HOLLY ST
Mailing Address - Street 2:STE. 323
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4364
Mailing Address - Country:US
Mailing Address - Phone:360-734-0592
Mailing Address - Fax:360-647-2076
Practice Address - Street 1:203 W HOLLY ST
Practice Address - Street 2:STE. 323
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4364
Practice Address - Country:US
Practice Address - Phone:360-734-0592
Practice Address - Fax:360-647-2076
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00000812106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1375RUOtherPROVIDER RIDER # FOR REGE