Provider Demographics
NPI:1891818308
Name:GOEDDEL, JUDY LYNN
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:LYNN
Last Name:GOEDDEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:GOEDDEL
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9532 W 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-1607
Mailing Address - Country:US
Mailing Address - Phone:303-237-1624
Mailing Address - Fax:
Practice Address - Street 1:1075 GALAPAGO ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-3942
Practice Address - Country:US
Practice Address - Phone:303-504-6810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist