Provider Demographics
NPI:1376611061
Name:DAKOSKE, JUDIANN RGOEI (MA)
Entity Type:Individual
Prefix:MRS
First Name:JUDIANN
Middle Name:RGOEI
Last Name:DAKOSKE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JUDIANN
Other - Middle Name:
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:4055 E THOUSAND OAKS BLVD
Mailing Address - Street 2:STE. 215
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3600
Mailing Address - Country:US
Mailing Address - Phone:805-497-7700
Mailing Address - Fax:805-497-7700
Practice Address - Street 1:4055 E THOUSAND OAKS BLVD
Practice Address - Street 2:STE. 215
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3600
Practice Address - Country:US
Practice Address - Phone:805-497-7700
Practice Address - Fax:805-497-7700
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31806106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist