Provider Demographics
NPI:1619481801
Name:JUDD, NATALIE L I
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:L
Last Name:JUDD
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:L
Other - Last Name:CLARK, DANKE, RECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7451 F AND S GRADE RD
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-8541
Mailing Address - Country:US
Mailing Address - Phone:360-420-8030
Mailing Address - Fax:
Practice Address - Street 1:1005 S. 3RD ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273
Practice Address - Country:US
Practice Address - Phone:360-419-3605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1041C0700XOtherLICSWA