Provider Demographics
NPI:1184695579
Name:GALLOWAY, JUDY ANN (EDD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:ANN
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:DR
Other - First Name:JUDY
Other - Middle Name:ANN
Other - Last Name:GALLOWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD
Mailing Address - Street 1:1155 LOUISIANA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2351
Mailing Address - Country:US
Mailing Address - Phone:407-620-8031
Mailing Address - Fax:
Practice Address - Street 1:1155 LOUISIANA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2351
Practice Address - Country:US
Practice Address - Phone:407-620-8031
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL04579101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health