Provider Demographics
NPI:1649837535
Name:JUDGE, YVONNE
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:JUDGE
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 1:450 W WILSON BRIDGE RD STE 350
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-5220
Mailing Address - Country:US
Mailing Address - Phone:614-245-5119
Mailing Address - Fax:
Practice Address - Street 1:2550 CORPORATE EXCHANGE DR STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-1660
Practice Address - Country:US
Practice Address - Phone:614-245-5119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-25
Last Update Date:2024-04-09
Deactivation Date:2020-08-27
Deactivation Code:
Reactivation Date:2022-10-18
Provider Licenses
StateLicense IDTaxonomies
106H00000X
OHF.2200283106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist