Provider Demographics
NPI:1710147772
Name:WALLIS, JUDY WERGER (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:WERGER
Last Name:WALLIS
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 1:301 N MALL ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2219
Mailing Address - Country:US
Mailing Address - Phone:337-237-4835
Mailing Address - Fax:
Practice Address - Street 1:301 N MALL ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2219
Practice Address - Country:US
Practice Address - Phone:337-237-4835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health