Provider Demographics
NPI:1619239431
Name:MORGAN, JUDITH C (RN/BA/CADC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:C
Last Name:MORGAN
Suffix:
Gender:F
Credentials:RN/BA/CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E SEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHLEY
Mailing Address - State:IL
Mailing Address - Zip Code:62808-4017
Mailing Address - Country:US
Mailing Address - Phone:618-242-1546
Mailing Address - Fax:618-242-6392
Practice Address - Street 1:16338 N ILLINOIS HWY 37
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864
Practice Address - Country:US
Practice Address - Phone:618-244-1534
Practice Address - Fax:618-242-6392
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YA0400X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)