Provider Demographics
NPI:1356760607
Name:COLLARD, JUDI (MSW)
Entity type:Individual
Prefix:MS
First Name:JUDI
Middle Name:
Last Name:COLLARD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 BUTTERCUP ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-4053
Mailing Address - Country:US
Mailing Address - Phone:512-789-1131
Mailing Address - Fax:
Practice Address - Street 1:2208 BUTTERCUP ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-4053
Practice Address - Country:US
Practice Address - Phone:512-789-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0009920385104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker