Provider Demographics
NPI:1225198666
Name:IGO, JUDITH D (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:D
Last Name:IGO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 E BRAEMERE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-1862
Mailing Address - Country:US
Mailing Address - Phone:208-387-1734
Mailing Address - Fax:208-383-1199
Practice Address - Street 1:1408 W HAYS
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-1862
Practice Address - Country:US
Practice Address - Phone:208-387-1741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC 129101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDQ3790OtherBLUE CROSS INS