Provider Demographics
NPI:1487678819
Name:FROST, JUDITH H (MSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:H
Last Name:FROST
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 N NARROWS DRIVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-1623
Mailing Address - Country:US
Mailing Address - Phone:253-752-7579
Mailing Address - Fax:
Practice Address - Street 1:2330 N NARROWS DR
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-1623
Practice Address - Country:US
Practice Address - Phone:253-752-7579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000078941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8858765Medicare PIN
WAQ64463Medicare UPIN