Provider Demographics
NPI:1891379202
Name:JUDD, TERILYN RAE (CRM, CADC I)
Entity Type:Individual
Prefix:
First Name:TERILYN
Middle Name:RAE
Last Name:JUDD
Suffix:
Gender:F
Credentials:CRM, CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1852
Mailing Address - Country:US
Mailing Address - Phone:971-232-2234
Mailing Address - Fax:503-303-7316
Practice Address - Street 1:504 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1852
Practice Address - Country:US
Practice Address - Phone:971-232-2234
Practice Address - Fax:503-303-7316
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)