Provider Demographics
NPI:1669114393
Name:WHITFIELD, JUDITH R (PSYD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:R
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 NE INSPIRATION ST
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-4515
Mailing Address - Country:US
Mailing Address - Phone:206-941-7143
Mailing Address - Fax:
Practice Address - Street 1:18820 FRONT ST NE STE 220
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7351
Practice Address - Country:US
Practice Address - Phone:206-941-7143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60280124101YM0800X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health