Provider Demographics
NPI:1164570842
Name:SCUDDER, DEBORAH K (MSW)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:K
Last Name:SCUDDER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W CAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:KELLOGG
Mailing Address - State:ID
Mailing Address - Zip Code:83837-2004
Mailing Address - Country:US
Mailing Address - Phone:208-784-1283
Mailing Address - Fax:208-784-0151
Practice Address - Street 1:601 W CAMERON AVE
Practice Address - Street 2:
Practice Address - City:KELLOGG
Practice Address - State:ID
Practice Address - Zip Code:83837-2004
Practice Address - Country:US
Practice Address - Phone:208-784-1283
Practice Address - Fax:208-784-0151
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCSW3651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical