Provider Demographics
NPI:1235645359
Name:JUDGE, JANICE WILES
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:WILES
Last Name:JUDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PFOUTS ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18706
Mailing Address - Country:US
Mailing Address - Phone:570-829-0795
Mailing Address - Fax:570-829-2294
Practice Address - Street 1:5 PFOUTS ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18706
Practice Address - Country:US
Practice Address - Phone:570-829-0795
Practice Address - Fax:570-829-2294
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0135311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical