Provider Demographics
NPI:1861006231
Name:JUDY, JANET LYNN
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LYNN
Last Name:JUDY
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 1:212 1/2 COURT AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-1449
Mailing Address - Country:US
Mailing Address - Phone:304-312-0222
Mailing Address - Fax:
Practice Address - Street 1:212 1/2 COURT AVE
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-1449
Practice Address - Country:US
Practice Address - Phone:304-312-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator