Provider Demographics
NPI:1215120548
Name:HOUSER, JUDY N
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:N
Last Name:HOUSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 COGSWELL ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3210
Mailing Address - Country:US
Mailing Address - Phone:321-632-8610
Mailing Address - Fax:
Practice Address - Street 1:1845 COGSWELL ST
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3210
Practice Address - Country:US
Practice Address - Phone:321-632-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7576421 00Medicaid