Provider Demographics
NPI:1104118868
Name:SWANK, JUDY LINN (MA)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:LINN
Last Name:SWANK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:CARLTON
Mailing Address - State:WA
Mailing Address - Zip Code:98814-0195
Mailing Address - Country:US
Mailing Address - Phone:509-923-1965
Mailing Address - Fax:509-923-1965
Practice Address - Street 1:136 MCFARLAND CRK RD.
Practice Address - Street 2:
Practice Address - City:METHOW
Practice Address - State:WA
Practice Address - Zip Code:98834
Practice Address - Country:US
Practice Address - Phone:509-923-1965
Practice Address - Fax:509-923-1965
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60222775174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist