Provider Demographics
NPI:1215123351
Name:STEVENSON, JUDITH LYNN (LMT)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:LYNN
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6085 LONDON GROVEPORT RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8947
Mailing Address - Country:US
Mailing Address - Phone:614-286-6795
Mailing Address - Fax:
Practice Address - Street 1:4610 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2247
Practice Address - Country:US
Practice Address - Phone:614-538-0983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.015954174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist