Provider Demographics
NPI:1942530258
Name:KIRKEBY, JUDITH LYNNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:LYNNE
Last Name:KIRKEBY
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 1:608 BELMONT AVE E APT 1
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-4876
Mailing Address - Country:US
Mailing Address - Phone:206-328-7987
Mailing Address - Fax:
Practice Address - Street 1:110 PREFONTAINE PL S STE 608
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2626
Practice Address - Country:US
Practice Address - Phone:206-389-2072
Practice Address - Fax:206-389-2083
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2349103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2349OtherSTATE PSYCHOLOGY LICENSE