Provider Demographics
NPI:1396868808
Name:ROBERTSON, JUDY ANN
Entity type:Individual
Prefix:MISS
First Name:JUDY
Middle Name:ANN
Last Name:ROBERTSON
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 1:1617 S WALKER LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95215-9604
Mailing Address - Country:US
Mailing Address - Phone:209-942-1912
Mailing Address - Fax:
Practice Address - Street 1:548 E PARK ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2134
Practice Address - Country:US
Practice Address - Phone:209-464-5519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor