Provider Demographics
NPI:1336361161
Name:CHAMBERS, JUDITH JANE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:JANE
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:CHAMBERS
Other - Last Name:OCONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1804 NE 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1416
Mailing Address - Country:US
Mailing Address - Phone:503-238-8685
Mailing Address - Fax:
Practice Address - Street 1:1804 NE 45TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1416
Practice Address - Country:US
Practice Address - Phone:503-238-8685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1735104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
R113927Medicare ID - Type Unspecified