Provider Demographics
NPI:1598100554
Name:LAUE, JUDITH ANNE (LMT, CCA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANNE
Last Name:LAUE
Suffix:
Gender:F
Credentials:LMT, CCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10245 SE BELL AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2228
Mailing Address - Country:US
Mailing Address - Phone:970-946-7727
Mailing Address - Fax:
Practice Address - Street 1:3716 SE INTERNATIONAL WAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97222-6001
Practice Address - Country:US
Practice Address - Phone:503-659-0073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-05
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20016172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker