Provider Demographics
NPI:1598992927
Name:JUDKINS, DEBORAH R (LIC MSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:R
Last Name:JUDKINS
Suffix:
Gender:F
Credentials:LIC MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 CEDAR ST
Mailing Address - Street 2:# 905
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-4100
Mailing Address - Country:US
Mailing Address - Phone:206-420-8857
Mailing Address - Fax:
Practice Address - Street 1:9040 REID ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-968-2252
Practice Address - Fax:253-968-3278
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066979-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health