Provider Demographics
NPI:1669136156
Name:JUDKINS, POLLYANN BROOKE (SUDPT)
Entity type:Individual
Prefix:
First Name:POLLYANN
Middle Name:BROOKE
Last Name:JUDKINS
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 MICHIGAN ST # A
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-4000
Mailing Address - Country:US
Mailing Address - Phone:509-820-6989
Mailing Address - Fax:
Practice Address - Street 1:515 LAKEWAY DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5233
Practice Address - Country:US
Practice Address - Phone:360-676-2187
Practice Address - Fax:360-676-2162
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61187243101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)