Provider Demographics
NPI:1801224266
Name:ACKEN, JUDITH WILDER
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:WILDER
Last Name:ACKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BATES AVE SW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-2953
Mailing Address - Country:US
Mailing Address - Phone:863-299-9686
Mailing Address - Fax:863-297-9772
Practice Address - Street 1:116 BATES AVE SW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-2953
Practice Address - Country:US
Practice Address - Phone:863-299-9686
Practice Address - Fax:863-297-9772
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 10996101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health