Provider Demographics
NPI:1417381690
Name:WEEMS, JUDITH RAE
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:RAE
Last Name:WEEMS
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 1:1245 BAIR RD NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-3299
Mailing Address - Country:US
Mailing Address - Phone:503-304-8073
Mailing Address - Fax:
Practice Address - Street 1:1245 BAIR RD NE
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-3299
Practice Address - Country:US
Practice Address - Phone:503-304-8073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-24
Last Update Date:2013-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst