Provider Demographics
NPI:1376150888
Name:JUDD, JESSICA LYNN (MS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:JUDD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:WANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16316 DOVETAIL WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34610-6512
Mailing Address - Country:US
Mailing Address - Phone:412-576-9304
Mailing Address - Fax:
Practice Address - Street 1:16316 DOVETAIL WAY
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34610-6512
Practice Address - Country:US
Practice Address - Phone:412-576-9304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health