Provider Demographics
NPI:1225033186
Name:MILBURN, JUDITH ANNETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANNETTE
Last Name:MILBURN
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 1:840 PAVILION PL
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-9130
Mailing Address - Country:US
Mailing Address - Phone:714-330-1245
Mailing Address - Fax:855-485-3130
Practice Address - Street 1:840 PAVILION PL
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-9130
Practice Address - Country:US
Practice Address - Phone:714-330-1245
Practice Address - Fax:855-485-3130
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5649103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR179612OtherPTAN
CACP5649OtherPTAN