Provider Demographics
NPI:1376693721
Name:ECKSTEIN, JUDITH KAREN (PHD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:KAREN
Last Name:ECKSTEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1652 NW HUGHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-8844
Mailing Address - Country:US
Mailing Address - Phone:541-673-3985
Mailing Address - Fax:541-673-8060
Practice Address - Street 1:1652 NW HUGHWOOD CT
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-8844
Practice Address - Country:US
Practice Address - Phone:541-673-3985
Practice Address - Fax:541-673-8060
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0710103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR816113003OtherREGENCE BLUE CROSS BLUE SHIELD
OR148817Medicaid
OR148817Medicaid