Provider Demographics
NPI:1306667985
Name:UDALL, LOUISA MICHELLE
Entity type:Individual
Prefix:
First Name:LOUISA
Middle Name:MICHELLE
Last Name:UDALL
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 1:1010 SOUTH VE ELLA CIRCLE
Mailing Address - Street 2:BLD 10 APARTMENT 211 MAILBOX 22
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 SOUTH VE ELLA CIRCLE
Practice Address - Street 2:BLD 10 APARTMENT 211 MAILBOX 22
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281
Practice Address - Country:US
Practice Address - Phone:480-772-2003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker