Provider Demographics
NPI:1780833731
Name:NELSON-BARNETT, JUDITH ROSE (MA, LP)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ROSE
Last Name:NELSON-BARNETT
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:ROSE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LP
Mailing Address - Street 1:32393 RENDOVA CIR NE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-6643
Mailing Address - Country:US
Mailing Address - Phone:612-554-0784
Mailing Address - Fax:
Practice Address - Street 1:32393 RENDOVA CIR NE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-6643
Practice Address - Country:US
Practice Address - Phone:612-554-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3100103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling