Provider Demographics
NPI:1790830149
Name:GUERTIN, JUDITH DANIELLE (MS)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:DANIELLE
Last Name:GUERTIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 WOODLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-2160
Mailing Address - Country:US
Mailing Address - Phone:907-248-3805
Mailing Address - Fax:
Practice Address - Street 1:4241 B ST
Practice Address - Street 2:SUITE 301
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5910
Practice Address - Country:US
Practice Address - Phone:907-338-1244
Practice Address - Fax:907-563-6546
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK0030101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional