Provider Demographics
NPI:1225181928
Name:SPILLANE, JUDY WOLFE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:WOLFE
Last Name:SPILLANE
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 1:1152 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-5517
Mailing Address - Country:US
Mailing Address - Phone:707-433-1766
Mailing Address - Fax:707-994-7349
Practice Address - Street 1:1152 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-5517
Practice Address - Country:US
Practice Address - Phone:707-433-1766
Practice Address - Fax:707-994-7349
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health