Provider Demographics
NPI:1669525218
Name:KALISKI, JUDITH PUTNAM (PHD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:PUTNAM
Last Name:KALISKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 EL CERRITO ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4667
Mailing Address - Country:US
Mailing Address - Phone:805-594-1026
Mailing Address - Fax:
Practice Address - Street 1:SAN LUIS OBISPO COMMUNITY MENTAL HEALTH IPU
Practice Address - Street 2:2179 JOHNSON AVE.
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93408-0001
Practice Address - Country:US
Practice Address - Phone:805-781-4712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1819103TC0700X
CAPSY10928103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical