Provider Demographics
NPI:1144419102
Name:GUEST-CALDWELL, JUDITH (LPC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:GUEST-CALDWELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 S 36TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-5924
Mailing Address - Country:US
Mailing Address - Phone:217-224-6300
Mailing Address - Fax:217-224-4329
Practice Address - Street 1:8965 HIGHWAY 36
Practice Address - Street 2:SUITE F
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6739
Practice Address - Country:US
Practice Address - Phone:573-221-7027
Practice Address - Fax:573-221-7028
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999139480101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional