Provider Demographics
NPI:1336230150
Name:RUDMAN, JUDITH CLARK (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:CLARK
Last Name:RUDMAN
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 1:3600 LINCOLN WAY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014
Mailing Address - Country:US
Mailing Address - Phone:515-239-4410
Mailing Address - Fax:515-663-4885
Practice Address - Street 1:3600 LINCOLN WAY
Practice Address - Street 2:SUITE 4
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014
Practice Address - Country:US
Practice Address - Phone:515-239-4410
Practice Address - Fax:515-663-4885
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00825103T00000X, 103TC0700X, 103TC2200X, 103TF0000X
IA00349103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily