Provider Demographics
NPI:1245389048
Name:VAPOREAN, JUDITH M (RNC,MSW,LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:M
Last Name:VAPOREAN
Suffix:
Gender:F
Credentials:RNC,MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 S PROVIDENCE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-3622
Mailing Address - Country:US
Mailing Address - Phone:573-875-0077
Mailing Address - Fax:573-875-0078
Practice Address - Street 1:3201 S PROVIDENCE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-3622
Practice Address - Country:US
Practice Address - Phone:573-875-0077
Practice Address - Fax:573-875-0078
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0049051041C0700X
MO093274163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health