Provider Demographics
NPI:1063579134
Name:EARLEY, JUDITH K (MFT)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:K
Last Name:EARLEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 WEST SIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-4369
Mailing Address - Country:US
Mailing Address - Phone:319-331-2327
Mailing Address - Fax:319-341-7727
Practice Address - Street 1:722 WEST SIDE DRIVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-4369
Practice Address - Country:US
Practice Address - Phone:319-331-2327
Practice Address - Fax:319-341-7727
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00230106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist