Provider Demographics
NPI:1225154552
Name:MILLER, JUDY ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JUDITH
Other - Middle Name:ANN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:10380 SW CANTERBURY LN
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-4810
Mailing Address - Country:US
Mailing Address - Phone:503-720-6372
Mailing Address - Fax:503-684-8513
Practice Address - Street 1:10445 SW CANTERBURY LN
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-4811
Practice Address - Country:US
Practice Address - Phone:503-720-6372
Practice Address - Fax:503-684-8513
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health