Provider Demographics
NPI:1760528517
Name:WATSON, JUDITH A (MED)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:A
Last Name:WATSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6217 SE 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-8105
Mailing Address - Country:US
Mailing Address - Phone:503-771-3698
Mailing Address - Fax:
Practice Address - Street 1:2130 SW 5TH AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-4976
Practice Address - Country:US
Practice Address - Phone:503-238-0769
Practice Address - Fax:503-963-7711
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health