Provider Demographics
NPI:1891868253
Name:BLUMENFELD, JUDY LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:LYNN
Last Name:BLUMENFELD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10303 N PORT WASHINGTON RD
Mailing Address - Street 2:SUITE203
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092
Mailing Address - Country:US
Mailing Address - Phone:262-241-5955
Mailing Address - Fax:262-241-5926
Practice Address - Street 1:10303 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE203
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092
Practice Address - Country:US
Practice Address - Phone:262-241-5955
Practice Address - Fax:262-241-5926
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI755103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0002 84437Medicare ID - Type Unspecified