Provider Demographics
NPI:1205591864
Name:MADROS, JUDY ANN
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:ANN
Last Name:MADROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:NULATO
Mailing Address - State:AK
Mailing Address - Zip Code:99765-0070
Mailing Address - Country:US
Mailing Address - Phone:907-799-6801
Mailing Address - Fax:
Practice Address - Street 1:4 NULATO RIVER ROAD
Practice Address - Street 2:
Practice Address - City:NULATO
Practice Address - State:AK
Practice Address - Zip Code:99765
Practice Address - Country:US
Practice Address - Phone:907-452-8251
Practice Address - Fax:907-459-3810
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
AK172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor